Provider Demographics
NPI:1477544310
Name:BI-STATE HOME HEALTH, INC.
Entity Type:Organization
Organization Name:BI-STATE HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICH
Authorized Official - Middle Name:R
Authorized Official - Last Name:HARL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-398-7285
Mailing Address - Street 1:430 REGENCY CTR
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-4659
Mailing Address - Country:US
Mailing Address - Phone:618-343-0325
Mailing Address - Fax:618-343-0314
Practice Address - Street 1:430 REGENCY CTR
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-4659
Practice Address - Country:US
Practice Address - Phone:618-343-0325
Practice Address - Fax:618-343-0314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010313251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid