Active NPI
Phoenix Home Care Illinois, LLC
- Nursing Care Agency
- O'Fallon, IL
National Provider Identifier
1720465834
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nursing Care Agency
- Legal business name
- PHOENIX HOME CARE ILLINOIS, LLC
- Practice address
- 784 Wall St
Suite B
O Fallon, IL 62269-1959 - Phone
- (314) 205-3020
- Fax
- (314) 205-3031
- NPI assigned
- Apr 28, 2015
- Organization subpart
- Yes
- Parent organization
- PHOENIX HOME CARE, INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- George Scott Herman
- Title
- President/Secretary
- Phone
- (512) 632-7156
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nursing Care Agency | 251J00000X | Primary |
Addresses
Primary practice location
784 Wall St
Suite B
O Fallon, IL 62269-1959
Mailing address
3450 N. Rock Rd
#213 Attn Debra Mullen
Wichita, KS 67226
Phone (316) 688-5511
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 266501303 | Medicaid | MO |
National Provider Directory
National Provider Directory- Part of
- Phoenix Home Care LLC
Locations
784 Wall St
Ste B
O Fallon, IL 62269
Phone (314) 205-3020
Ownership & related parties
Parent organization (reported in NPPES) 1
This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.
-
- Home Health Agency
- Burr Ridge, IL
- NPI 1013928357
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1430179200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1638489600000",
"number": "1720465834",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3450 N. ROCK RD",
"address_2": "#213 ATTN DEBRA MULLEN",
"city": "WICHITA",
"state": "KS",
"postal_code": "67226",
"telephone_number": "316-688-5511",
"fax_number": "314-205-3031"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "784 WALL ST",
"address_2": "SUITE B",
"city": "O FALLON",
"state": "IL",
"postal_code": "622691959",
"telephone_number": "314-205-3020",
"fax_number": "314-205-3031"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PHOENIX HOME CARE ILLINOIS, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "PHOENIX HOME CARE, INC",
"enumeration_date": "2015-04-28",
"last_updated": "2021-12-03",
"certification_date": "2021-12-03",
"status": "A",
"authorized_official_last_name": "HERMAN",
"authorized_official_first_name": "GEORGE",
"authorized_official_middle_name": "SCOTT",
"authorized_official_title_or_position": "PRESIDENT/SECRETARY",
"authorized_official_telephone_number": "512-632-7156"
},
"taxonomies": [
{
"code": "251J00000X",
"taxonomy_group": "",
"desc": "Nursing Care",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "266501303",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in O'Fallon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.