Provider Demographics
NPI:1114915675
Name:HELIA HEALTHCARE OF JERSEYVILLE LLC
Entity Type:Organization
Organization Name:HELIA HEALTHCARE OF JERSEYVILLE LLC
Other - Org Name:JERSEYVILLE NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPAL/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-994-2306
Mailing Address - Street 1:500 NW PLAZA DR STE 712
Mailing Address - Street 2:
Mailing Address - City:SAINT ANN
Mailing Address - State:MO
Mailing Address - Zip Code:63074-2222
Mailing Address - Country:US
Mailing Address - Phone:314-317-2003
Mailing Address - Fax:312-896-5951
Practice Address - Street 1:1001 S STATE ST
Practice Address - Street 2:
Practice Address - City:JERSEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62052-2361
Practice Address - Country:US
Practice Address - Phone:618-498-6496
Practice Address - Fax:618-498-7435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1584531314000000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL371323741002Medicaid
IL371323741002Medicaid
0961260001Medicare NSC