Provider Demographics
NPI:1568562858
Name:EL PASO HCO LLC
Entity type:Organization
Organization Name:EL PASO HCO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE COMPLIANCE AUDITOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:REDBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-444-0900
Mailing Address - Street 1:850 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:IL
Mailing Address - Zip Code:61738-1309
Mailing Address - Country:US
Mailing Address - Phone:095-272-7003
Mailing Address - Fax:816-276-0150
Practice Address - Street 1:850 E 2ND ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:IL
Practice Address - Zip Code:61738-1309
Practice Address - Country:US
Practice Address - Phone:309-527-2700
Practice Address - Fax:309-527-2725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0046706314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL270376016013Medicaid
IL=========013Medicaid
146097Medicare Oscar/Certification