MEDICARE: SULLIVAN HOME HEALTH PRODUCTS, INC.

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
1	332B00000X	Durable Medical Equipment & Medical Supplies	203-000287	IL

General Provider Information

NPI Number	:	1891770509
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SULLIVAN HOME HEALTH PRODUCTS, INC.

Provider Business Mailing Address
First Line	:	311 BERRY ST
Second Line	:	POB 9
City	:	HILLSBORO
State	:	IL
Zip	:	62049-1201
Country	:	US
Telephone Number	:	217-532-6366
Fax Number	:	217-532-3106

Provider Business Practice Location Address
First Line	:	311 BERRY ST
Second Line	:	POB 9
City	:	HILLSBORO
State	:	IL
Zip	:	62049-1201
Country	:	US
Telephone Number	:	217-532-6366
Fax Number	:	217-532-3106

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MAURICE E. SULLIVAN
Credential	:	R.PH.
Telephone Number	:	217-839-2909

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	09/23/2009

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