1922096320 NPI number — HELIA HEALTHCARE OF HILLSBORO, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922096320 NPI number — HELIA HEALTHCARE OF HILLSBORO, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HELIA HEALTHCARE OF HILLSBORO, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MONTGOMERY NURSING & REHAB CTR
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922096320
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 NW PLAZA DR STE 712
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT ANN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63074-2222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-566-0459
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9086 ILLINOIS
Provider Second Line Business Practice Location Address:
ROUTE 127
Provider Business Practice Location Address City Name:
HILLSBORO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-532-6126
Provider Business Practice Location Address Fax Number:
217-532-9465
Provider Enumeration Date:
10/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRINCIPAL/MEMBER
Authorized Official Telephone Number:
312-994-2306

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  1509730 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 371323740001 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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