Provider Demographics
NPI:1528043700
Name:SULLIVAN HOME HEALTH PRODUCTS, INC.
Entity Type:Organization
Organization Name:SULLIVAN HOME HEALTH PRODUCTS, INC.
Other - Org Name:SULLIVAN HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESICENT
Authorized Official - Prefix:
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:E
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:217-839-2909
Mailing Address - Street 1:117 W SPRUCE ST
Mailing Address - Street 2:POB 59
Mailing Address - City:GILLESPIE
Mailing Address - State:IL
Mailing Address - Zip Code:62033-1614
Mailing Address - Country:US
Mailing Address - Phone:217-839-3228
Mailing Address - Fax:217-839-2282
Practice Address - Street 1:117 W SPRUCE ST
Practice Address - Street 2:POB 59
Practice Address - City:GILLESPIE
Practice Address - State:IL
Practice Address - Zip Code:62033-1614
Practice Address - Country:US
Practice Address - Phone:217-839-3228
Practice Address - Fax:217-839-2282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-12
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL0295720001Medicare NSC