Healthcare Provider Details

I. General information

NPI: 1831008317
Provider Name (Legal Business Name): ALIX HOME HEALTHCARE ILLINOIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 STATE ST
EAST SAINT LOUIS IL
62205-2320
US

IV. Provider business mailing address

2415 STATE ST
EAST SAINT LOUIS IL
62205-2320
US

V. Phone/Fax

Practice location:
  • Phone: 618-515-3043
  • Fax:
Mailing address:
  • Phone: 618-515-3043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. STACEY BLACKMON
Title or Position: OWNER
Credential:
Phone: 314-402-3992