Provider Healthcare Services, Inc

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

1011663 Issued in IL

Legal business name

PROVIDER HEALTHCARE SERVICES, INC

Practice address

555 South Schuyler
Suite 275
Kankakee, IL 60901

Phone

(773) 301-8464

Fax

(773) 530-2643

NPI assigned

Oct 24, 2014

Organization subpart

No

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

Authorized official

Name

Mr. Sulaimon K OladipoNPI 1558765164

Title

President

Phone

(773) 301-8464

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sulaimon Kehinde Oladipo

  • Psychiatric/Mental Health Nurse Practitioner
  • Chicago, IL
  • NPI 1558765164
  Authorized official Same address or phone
• Jamila Moninuola Oladipo, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Pontiac, IL
  • NPI 1679108153
  NPD (past)

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

{
    "created_epoch": "1414108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414368000000",
    "number": "1417352105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 S SCHUYLER AVE",
            "address_2": "SUITE 275",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609015146",
            "telephone_number": "773-301-8464",
            "fax_number": "773-530-2643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 SOUTH SCHUYLER",
            "address_2": "SUITE 275",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "60901",
            "telephone_number": "773-301-8464",
            "fax_number": "773-530-2643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDER HEALTHCARE SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-24",
        "last_updated": "2014-10-27",
        "status": "A",
        "authorized_official_last_name": "OLADIPO",
        "authorized_official_first_name": "SULAIMON",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-301-8464",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "IL",
            "license": "1011663",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Prime Healthcare Home Care and Hospice, LLC (Prime Home Care - Kankakee)
• Prime Healthcare Living - Heritage Village LLC
• Prime Healthcare Living - Resurrection Place LLC
• Prime Healthcare Senior Living, LLC (Heritage Village)
• McKenna Rose Printy, APRN, FNP-BC
• Samia Qadir, DO
• Holly J Quint
• Omar Ahmed Rafa, DO
• Raffi Leblebijian Dr Raffi Leblebijian & Assoc
• Robert Alan Raley, DPM

• Home Health Agency in Kankakee, IL
• Providers in Kankakee, IL by specialty
• Home Health Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2014; 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.