Provider Demographics
NPI:1982607123
Name:MEMORIAL HOME SERVICES
Entity Type:Organization
Organization Name:MEMORIAL HOME SERVICES
Other - Org Name:MEMORIAL HOME HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR- HOME HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:217-788-4663
Mailing Address - Street 1:701 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62781-4952
Mailing Address - Country:US
Mailing Address - Phone:217-788-4663
Mailing Address - Fax:
Practice Address - Street 1:701 N 1ST ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62781-4952
Practice Address - Country:US
Practice Address - Phone:217-788-4663
Practice Address - Fax:217-788-5557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1002377251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL137487OtherHEALTHLINK
IL009326OtherHEALTH ALLIANCE MED PLAN
ILL016474OtherTRICARE
IL9866OtherBLUE CROSS BLUE SHIELD HH
ILL016474OtherTRICARE
IL137487OtherHEALTHLINK