Healthcare Provider Details

I. General information

NPI: 1093759763
Provider Name (Legal Business Name): HELIA HEALTHCARE OF CHAMPAIGN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 10/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 S MATTIS AVE
CHAMPAIGN IL
61821-5919
US

IV. Provider business mailing address

1111 WESTGATE TERRACE SUITE 110
OAK PARK IL
60301
US

V. Phone/Fax

Practice location:
  • Phone: 217-352-0516
  • Fax:
Mailing address:
  • Phone: 312-994-2306
  • Fax: 312-896-5951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0041897
License Number StateIL

VIII. Authorized Official

Name: STEPHEN MILLER
Title or Position: MEMBER
Credential:
Phone: 312-994-2306