Healthcare Provider Details

I. General information

NPI: 1700402690
Provider Name (Legal Business Name): BARBER CHRISTIAN HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 LINCOLN PLACE CT STE 202
BELLEVILLE IL
62221-5880
US

IV. Provider business mailing address

122 LINCOLN PLACE CT STE 202
BELLEVILLE IL
62221-5880
US

V. Phone/Fax

Practice location:
  • Phone: 217-732-5104
  • Fax:
Mailing address:
  • Phone: 217-732-5104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: BARBARA A CLOTT
Title or Position: DIRECTOR OF AR
Credential:
Phone: 217-732-5155