Healthcare Provider Details

I. General information

NPI: 1235556838
Provider Name (Legal Business Name): RESIDENTIAL HOME HEALTH OF SOUTHERN ILLINOIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2014
Last Update Date: 06/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 AIRWAY DR STE 1
MARION IL
62959-5841
US

IV. Provider business mailing address

5440 CORPORATE DR STE 400
TROY MI
48098-2645
US

V. Phone/Fax

Practice location:
  • Phone: 800-642-6099
  • Fax: 888-229-8388
Mailing address:
  • Phone: 866-902-4000
  • Fax: 866-903-4000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DAVID CURTIS
Title or Position: PRESIDENT
Credential:
Phone: 248-524-6401