Provider Demographics
NPI:1588085179
Name:HEALTHLINE IN-HOME CARE OF IL, LLC
Entity type:Organization
Organization Name:HEALTHLINE IN-HOME CARE OF IL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SMACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-386-8228
Mailing Address - Street 1:910 KEHRS MILL RD STE 105
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2404
Mailing Address - Country:US
Mailing Address - Phone:636-386-8228
Mailing Address - Fax:636-386-8245
Practice Address - Street 1:5003 N ILLINOIS ST
Practice Address - Street 2:SUITE 1
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-3419
Practice Address - Country:US
Practice Address - Phone:618-671-6524
Practice Address - Fax:618-671-6523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-26
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care