Healthcare Provider Details

I. General information

NPI: 1891770509
Provider Name (Legal Business Name): SULLIVAN HOME HEALTH PRODUCTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 09/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 BERRY ST POB 9
HILLSBORO IL
62049-1201
US

IV. Provider business mailing address

311 BERRY ST POB 9
HILLSBORO IL
62049-1201
US

V. Phone/Fax

Practice location:
  • Phone: 217-532-6366
  • Fax: 217-532-3106
Mailing address:
  • Phone: 217-532-6366
  • Fax: 217-532-3106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number203-000287
License Number StateIL

VIII. Authorized Official

Name: MAURICE E. SULLIVAN
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 217-839-2909