Healthcare Provider Details

I. General information

NPI: 1053215020
Provider Name (Legal Business Name): RENEA M KING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25501 LONGVIEW RD
HOPEDALE IL
61747-9599
US

IV. Provider business mailing address

25501 LONGVIEW RD
HOPEDALE IL
61747-9599
US

V. Phone/Fax

Practice location:
  • Phone: 217-649-4800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number194008262
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: