NPIMap

Individual provider Active NPI

Tishieka Hollingsworth

  • Homemaker
  • Park Forest, IL
National Provider Identifier
1053910505
Registry record updated Oct 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
HomemakerTaxonomy code 376J00000X
License
3001188 Issued in IL
Practice address
220 Forest Blvd
Park Forest, IL 60466-2032
Phone
(708) 980-1018
Fax
(866) 630-3186
NPI assigned
Oct 25, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 25, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
In Home Supportive Care Agency 253Z00000X 3001188 IL
Attendant Care Provider 3747A0650X 3001188 IL
Personal Care Attendant 3747P1801X 3001188 IL
Home Health Aide 374U00000X 3001188 IL
Homemaker 376J00000X 3001188 IL Primary

Addresses

Primary practice location

220 Forest Blvd
Park Forest, IL 60466-2032

Mailing address

220 Forest Blvd
Park Forest, IL 60466-2032
Phone (708) 980-1018

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
3001188ILMDIn Home Supportive Care Agency

Practice roles

OrganizationSpecialtyStatusNew patients
Rosie Mae Home Care, LLC-Supportive Living Current Accepting new patients
Rosie Mae Home Care, LLC In Home Supportive Care Current Accepting new patients

Locations

220 Forest Blvd
University Park, IL 60466
Phone (708) 980-1018

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603584000000",
    "number": "1053910505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 FOREST BLVD",
            "city": "PARK FOREST",
            "state": "IL",
            "postal_code": "604662032",
            "telephone_number": "708-980-1018",
            "fax_number": "866-630-3186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 FOREST BLVD",
            "city": "PARK FOREST",
            "state": "IL",
            "postal_code": "604662032",
            "telephone_number": "708-980-1018",
            "fax_number": "866-630-3186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLINGSWORTH",
        "first_name": "TISHIEKA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-25",
        "last_updated": "2020-10-25",
        "certification_date": "2020-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "IL",
            "license": "3001188",
            "primary": false
        },
        {
            "code": "3747A0650X",
            "taxonomy_group": "",
            "desc": "Technician, Attendant Care Provider",
            "state": "IL",
            "license": "3001188",
            "primary": false
        },
        {
            "code": "3747P1801X",
            "taxonomy_group": "",
            "desc": "Technician, Personal Care Attendant",
            "state": "IL",
            "license": "3001188",
            "primary": false
        },
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": "IL",
            "license": "3001188",
            "primary": false
        },
        {
            "code": "376J00000X",
            "taxonomy_group": "",
            "desc": "Homemaker",
            "state": "IL",
            "license": "3001188",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Park Forest, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.