MEDICARE: OLLIE HOME CARE SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1679242226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLLIE HOME CARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	1816 ALBERT ST
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62702-3129
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1816 ALBERT ST
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62702-3129
Country	:	US
Telephone Number	:	217-671-9846
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	MONTE TURNER
Credential	:
Telephone Number	:	217-671-9846

Provider Enumeration Date	:	09/08/2021
Last Update Date	:	09/08/2021

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