Provider Demographics
NPI:1235556838
Name:RESIDENTIAL HOME HEALTH OF SOUTHERN ILLINOIS, LLC
Entity Type:Organization
Organization Name:RESIDENTIAL HOME HEALTH OF SOUTHERN ILLINOIS, LLC
Other - Org Name:CELTIC HEALTHCARE OF S. IL, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-524-6401
Mailing Address - Street 1:5440 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-2645
Mailing Address - Country:US
Mailing Address - Phone:866-902-4000
Mailing Address - Fax:866-903-4000
Practice Address - Street 1:104 AIRWAY DR STE 1
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5841
Practice Address - Country:US
Practice Address - Phone:800-642-6099
Practice Address - Fax:888-229-8388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-21
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
14-7112Medicare PIN