Provider Demographics
NPI:1417775628
Name:PHILLIPS INVESTMENTS, LLC - BETHALTO OPERATIONS SERIES
Entity type:Organization
Organization Name:PHILLIPS INVESTMENTS, LLC - BETHALTO OPERATIONS SERIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:217-345-5022
Mailing Address - Street 1:2402 18TH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-4343
Mailing Address - Country:US
Mailing Address - Phone:217-345-5022
Mailing Address - Fax:
Practice Address - Street 1:312 MECHANICAL DR
Practice Address - Street 2:
Practice Address - City:EAST ALTON
Practice Address - State:IL
Practice Address - Zip Code:62024-2008
Practice Address - Country:US
Practice Address - Phone:618-717-0820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHILLIPS INVESTMENTS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility