Provider Demographics
NPI:1891770509
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:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
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 1:311 BERRY ST
Mailing Address - Street 2:POB 9
Mailing Address - City:HILLSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62049-1201
Mailing Address - Country:US
Mailing Address - Phone:217-532-6366
Mailing Address - Fax:217-532-3106
Practice Address - Street 1:311 BERRY ST
Practice Address - Street 2:POB 9
Practice Address - City:HILLSBORO
Practice Address - State:IL
Practice Address - Zip Code:62049-1201
Practice Address - Country:US
Practice Address - Phone:217-532-6366
Practice Address - Fax:217-532-3106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203-000287332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002Medicaid
IL0295720002Medicare NSC
IL0295720002Medicare ID - Type Unspecified