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NPI Code Detail

MEDICARE: CARETENDERS VISITING SERVICES OF SOUTHERN ILLINOIS, LLC

MEDICARE: CARETENDERS VISITING SERVICES OF SOUTHERN ILLINOIS, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251E00000XHome Health Agency

General Provider Information

NPI Number : 1770652919
Entity Type Code : Organization
Provider Name (Legal Business Name) : CARETENDERS VISITING SERVICES OF SOUTHERN ILLINOIS, LLC
Provider Business Mailing Address
First Line : PO BOX 51266
Second Line :
City : LAFAYETTE
State : LA
Zip : 70505-1266
Country : US
Telephone Number : 337-233-1307
Fax Number : 337-443-4154
Provider Business Practice Location Address
First Line : 141 MARKET PL STE 110
Second Line :
City : FAIRVIEW HEIGHTS
State : IL
Zip : 62208-2034
Country : US
Telephone Number : 618-277-8899
Fax Number : 618-277-8628
Authorized Official
Title or Position : CHIEF ADMINISTRATIVE OFFICER
Name : MR. MARCUS MACIP
Credential :
Telephone Number : 337-233-1307
Provider Enumeration Date : 11/06/2006
Last Update Date : 04/10/2023

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