Healthcare Provider Details

I. General information

NPI: 1497927735
Provider Name (Legal Business Name): HELIA HEALTHCARE OF BENTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
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: 618-493-3500
  • Fax:
Mailing address:
  • Phone: 618-493-3500
  • 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: STEPHEN MILLER
Title or Position: PRINCIPAL
Credential:
Phone: 312-994-2306