Provider Demographics
NPI:1346073152
Name:PRIVATE HOME CARE OF ILLINOIS LLC
Entity type:Organization
Organization Name:PRIVATE HOME CARE OF ILLINOIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-713-1268
Mailing Address - Street 1:9338 OLIVE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-3248
Mailing Address - Country:US
Mailing Address - Phone:618-713-1268
Mailing Address - Fax:
Practice Address - Street 1:111 E 4TH ST STE 110
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6206
Practice Address - Country:US
Practice Address - Phone:618-558-5299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care