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General NPI Number Information
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NPI Number | 1376166637
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Entity Type | Organization
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Legal Business Name | SPRINGFIELD ILLINOIS HOMECARE LLC
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Dates
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Enumeration Date | 05/21/2020
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Last Update Date | 08/17/2023
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Provider Practice Location Address
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Address Line | 2731 S MACARTHUR BLVD STE 201
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City | SPRINGFIELD
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State | IL
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Zip | 62704-5081
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Country | US
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Telephone | 217-299-2928
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Fax | 217-568-6309
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Provider Business Mailing Address
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Address Line | 2731 S MACARTHUR BLVD STE 201
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City | SPRINGFIELD
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State | IL
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Zip | 62704-5081
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Country | US
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Telephone | 217-299-2928
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Fax | 217-568-6309
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Authorized Official
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Title or Position | OWNER/EXECUTIVE DIRECTOR
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Name | MR. ROD A LANE
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Credential | MBA
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Telephone | 217-299-2928
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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