National Provider Identifier Database

PHOENIX HOME CARE ILLINOIS LLC
Nursing Care

A Nursing Care Agency is an entity that provides skilled nursing care through the services of a Registered Nurse (RN) or a Licensed Practical Nurse (LPN), by employees, contracted individuals, or via a registry, in a variety of settings. The agency may engage in providing private duty nursing and/or staffing services.


Contact Information

PHOENIX HOME CARE ILLINOIS, LLC
784 WALL ST
SUITE B
O'FALLON, IL62269-1959
Phone: 314-205-3020
Fax: 314-205-3031
Website:
Specialty Taxonomy Code
* Nursing Care 251J00000X

* Indicates primary specialty

NPI Profile & details for PHOENIX HOME CARE ILLINOIS, LLC

NPI Number 1720465834
Legal business name
LBN
PHOENIX HOME CARE ILLINOIS, LLC
Authorized official GEORGE HERMAN - (PRESIDENT/SECRETARY)
Entity Organization
Organization subpart Yes
Enumeration date 04/28/2015
Last updated 12/03/2021 - About 5 years ago
Sole proprietor1 Not specified
Identifiers
  • MO Medicaid: 266501303

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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