Healthcare Provider Details

I. General information

NPI: 1689670382
Provider Name (Legal Business Name): DYNAMIC HOMECARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 W LINCOLN AVE
CHARLESTON IL
61920-2442
US

IV. Provider business mailing address

546 W LINCOLN AVE
CHARLESTON IL
61920-2442
US

V. Phone/Fax

Practice location:
  • Phone: 217-345-4614
  • Fax: 217-348-0057
Mailing address:
  • Phone: 217-345-4614
  • Fax: 217-348-0057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1642234
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number1655311
License Number StateIL

VIII. Authorized Official

Name: MRS. DEATRICE ELLEN GREATHOUSE
Title or Position: CEO
Credential: RN
Phone: 217-345-4614