Healthcare Provider Details

I. General information

NPI: 1013272285
Provider Name (Legal Business Name): HELIA HEALTHCARE OF BENTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 07/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 MARK FRANKLIN DR
BENTON IL
62812-2049
US

IV. Provider business mailing address

1310 MARK FRANKLIN DR
BENTON IL
62812-2049
US

V. Phone/Fax

Practice location:
  • Phone: 618-439-3500
  • Fax:
Mailing address:
  • Phone: 618-439-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number005231
License Number StateIL

VIII. Authorized Official

Name: THERESA CONROY
Title or Position: DIRECTOR OF ACCOUNTS RECEIVABLE
Credential:
Phone: 314-431-0511