Healthcare Provider Details

I. General information

NPI: 1609864081
Provider Name (Legal Business Name): HELIA HEALTHCARE OF POPLAR BLUFF, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 WARRIOR LN
POPLAR BLUFF MO
63901-8686
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 573-785-0851
  • Fax: 573-785-6703
Mailing address:
  • Phone: 314-566-0459
  • Fax:

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 Number031640
License Number StateMO

VIII. Authorized Official

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