Provider Demographics
NPI:1003935560
Name:MEMORIAL HOME SERVICES
Entity Type:Organization
Organization Name:MEMORIAL HOME SERVICES
Other - Org Name:MEMORIAL HOME HOSPICE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR- HOSPICE
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WALCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-788-4663
Mailing Address - Street 1:701 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62781-4952
Mailing Address - Country:US
Mailing Address - Phone:217-788-4663
Mailing Address - Fax:
Practice Address - Street 1:701 N 1ST ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62781-4952
Practice Address - Country:US
Practice Address - Phone:217-788-4663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2000719251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL009326OtherHEALTH ALLIANCE
IL137487OtherHEALTHLINK
IL9575OtherBLUE CROSS BLUE SHIELD
ILL016474OtherTRICARE
ILL016474OtherTRICARE
ILL016474OtherTRICARE