Healthcare Provider Details

I. General information

NPI: 1043223290
Provider Name (Legal Business Name): GALESBURG HOME CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 N SOMMER ST SUITE 303
PEORIA IL
61615-1934
US

IV. Provider business mailing address

7800 N SOMMER ST SUITE 303
PEORIA IL
61615-1934
US

V. Phone/Fax

Practice location:
  • Phone: 309-693-9881
  • Fax: 309-693-9882
Mailing address:
  • Phone: 309-693-9881
  • Fax: 309-693-9882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number203000816
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number203000816
License Number StateIL

VIII. Authorized Official

Name: GARY D NEWSOME
Title or Position: PRESIDENT
Credential:
Phone: 615-465-7000