Healthcare Provider Details

I. General information

NPI: 1114915675
Provider Name (Legal Business Name): HELIA HEALTHCARE OF JERSEYVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S STATE ST
JERSEYVILLE IL
62052-2361
US

IV. Provider business mailing address

500 NW PLAZA DR STE 712
SAINT ANN MO
63074-2222
US

V. Phone/Fax

Practice location:
  • Phone: 618-498-6496
  • Fax: 618-498-7435
Mailing address:
  • Phone: 314-317-2003
  • Fax: 312-896-5951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1584531
License Number StateIL

VIII. Authorized Official

Name: STEPHEN P MILLER
Title or Position: PRINCIPAL/MEMBER
Credential:
Phone: 312-994-2306