Provider Demographics
NPI:1407281447
Name:HEALTHLINE HOMECARE AGENCY OF IL LLC
Entity Type:Organization
Organization Name:HEALTHLINE HOMECARE AGENCY 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 1:6600 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-3037
Mailing Address - Country:US
Mailing Address - Phone:618-213-8172
Mailing Address - Fax:618-213-7507
Practice Address - Street 1:6600 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-3037
Practice Address - Country:US
Practice Address - Phone:618-213-8172
Practice Address - Fax:618-213-7507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health