Provider Demographics
NPI:1497927735
Name:HELIA HEALTHCARE OF BENTON, LLC
Entity Type:Organization
Organization Name:HELIA HEALTHCARE OF BENTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-994-2306
Mailing Address - Street 1:1310 MARK FRANKLIN DR
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:IL
Mailing Address - Zip Code:62812-2049
Mailing Address - Country:US
Mailing Address - Phone:618-493-3500
Mailing Address - Fax:
Practice Address - Street 1:1310 MARK FRANKLIN DR
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:IL
Practice Address - Zip Code:62812-2049
Practice Address - Country:US
Practice Address - Phone:618-493-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL005231314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL146088Medicare Oscar/Certification