Provider Demographics
NPI:1013037795
Name:MEMORIAL HOME SERVICES OF CENTRAL ILLINOIS, INC
Entity Type:Organization
Organization Name:MEMORIAL HOME SERVICES OF CENTRAL ILLINOIS, INC
Other - Org Name:ALTERNATIVE CARE SERVICES, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR DURABLE MEDICAL EQUIPMENT
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:VALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-788-4663
Mailing Address - Street 1:644 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-5222
Mailing Address - Country:US
Mailing Address - Phone:217-788-4663
Mailing Address - Fax:217-788-5597
Practice Address - Street 1:1935 BELT WAY DR
Practice Address - Street 2:
Practice Address - City:OVERLAND
Practice Address - State:MO
Practice Address - Zip Code:63114-5825
Practice Address - Country:US
Practice Address - Phone:314-205-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054-0148283336H0001X, 3336S0011X
IL054-0140843336H0001X, 3336S0011X
MO0048573336H0001X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy