Provider Demographics
NPI:1447235601
Name:SPOON RIVER HOME HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:SPOON RIVER HOME HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:PLATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-228-4842
Mailing Address - Street 1:48 N EAST ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61531-1213
Mailing Address - Country:US
Mailing Address - Phone:309-245-0720
Mailing Address - Fax:309-245-0713
Practice Address - Street 1:48 N EAST ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61531-1213
Practice Address - Country:US
Practice Address - Phone:309-245-0720
Practice Address - Fax:309-245-0713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1007335251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL147530Medicare Oscar/Certification
IL=========001Medicaid