Healthcare Provider Details

I. General information

NPI: 1477544310
Provider Name (Legal Business Name): BI-STATE HOME HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 REGENCY CTR
COLLINSVILLE IL
62234-4659
US

IV. Provider business mailing address

430 REGENCY CTR
COLLINSVILLE IL
62234-4659
US

V. Phone/Fax

Practice location:
  • Phone: 618-343-0325
  • Fax: 618-343-0314
Mailing address:
  • Phone: 618-343-0325
  • Fax: 618-343-0314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1010313
License Number StateIL

VIII. Authorized Official

Name: MR. RICH R HARL
Title or Position: OWNER
Credential:
Phone: 314-398-7285