Provider Demographics
NPI:1538782172
Name:MEMORIAL HOME SERVICES OF CENTRAL ILLINOIS, INC
Entity type:Organization
Organization Name:MEMORIAL HOME SERVICES OF CENTRAL ILLINOIS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, DME
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-582-8667
Mailing Address - Street 1:644 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-5222
Mailing Address - Country:US
Mailing Address - Phone:217-757-7103
Mailing Address - Fax:
Practice Address - Street 1:2875 N WATER ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-4233
Practice Address - Country:US
Practice Address - Phone:217-876-4040
Practice Address - Fax:217-876-4075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies