Provider Demographics
NPI:1588930549
Name:A&V HOMECARE SERVICES, INC.
Entity type:Organization
Organization Name:A&V HOMECARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:OLUDARE
Authorized Official - Last Name:SHOLANKE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, MS, QIDP
Authorized Official - Phone:708-535-4388
Mailing Address - Street 1:15000 CICERO AVE STE 2E
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-1481
Mailing Address - Country:US
Mailing Address - Phone:708-535-4388
Mailing Address - Fax:708-535-8221
Practice Address - Street 1:15000 CICERO AVE STE 2E
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-1481
Practice Address - Country:US
Practice Address - Phone:708-535-4388
Practice Address - Fax:708-535-8221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-23
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251E00000X, 251C00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services