Memorial Home Services
Organization Active NPI Home Health Agency · Springfield, IL
NPI 1982607123 · NPPES record last updated May 30, 2024
Key facts
- NPI
- 1982607123
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- License
- 1002377 (IL)
- Legal business name
- MEMORIAL HOME SERVICES
- Practice address
- 701 N 1St St
Springfield, IL 62781-4952 - Phone
- (217) 788-4663
- Fax
- (217) 788-5557
- NPI assigned
- May 23, 2005
- Organization subpart
- No
Authorized official
- Name
- Christina Ann King, RN, BSN
- Title
- Director- Home Health
- Phone
- (217) 788-4663
Owners & managing parties with NPI records 1
Other NPIs with the same Medicare PAC ID 1
Member of 1
Affiliated clinicians 8
-
Bryan J. Kellenberger, M.D.
-
Roger S. McClintock, M.D.
-
Erin E Noblitt, NP
-
Jacob David Sams, MD
-
Donald Nicholas Sullivan, M.D.
-
Kenneth Tuan, M.D.
Medicare Care Compare: Home health agency
- Listed as
- Memorial Home Services
- Overall star rating
- ★★★☆☆ 3 of 5
- Ownership
- Non-Profit
- Certified
- Jul 1, 1966
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Home health agency certification: CCN 147003
- Legal name
- MEMORIAL HOME SERVICES
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Jul 1, 1966
- Last certification
- Jan 28, 2020
- Ownership / control type
- Non-Profit
- Organization structure
- Corporation · Non-profit
- Incorporated
- Feb 21, 1916 in IL
- Enrollment address
- 701 North First Street, Mailbox 15
Springfield, IL 62781
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Kimberly L Bourne |
Corporate Director | Feb 20, 2020 | |
| Tamar Kutz |
Corporate Director | Feb 20, 2020 | |
| Jameson Roszhart |
Corporate Officer | Feb 20, 2020 | |
| Kevin R England |
Corporate Director | Jan 1, 2009 | |
| Michael T Huffman |
Corporate Director | Jan 1, 2025 | |
| Dolan Dalpoas |
Corporate Director | Jan 1, 2009 | |
| Kathryn J Keim |
Corporate Officer | Feb 20, 2020 | |
| Memorial Home Services |
5% Or Greater Direct Ownership Interest | Jun 13, 1984 | |
| Henry Hurwitz |
Corporate Officer | Jan 1, 2025 | |
| Christina King |
Corporate Director |
Dec 31, 2018 | |
| Operational/Managerial Control |
Dec 31, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080604000272 | IL | Part a Provider - Home Health Agency | 8527069715 | Practice locations: Decatur, IL; Springfield, IL |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 1002377 | IL | Yes |
Addresses
Primary practice location
701 N 1St St
Springfield, IL 62781-4952
Mailing address
701 N 1St St
Springfield, IL 62781-4952
Phone (217) 788-4663
Other practice location 1
2300 N Edward St
Decatur, IL 62526-4163
Phone (217) 788-4663
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 137487 | Other | IL | HEALTHLINK |
| 009326 | Other | IL | HEALTH ALLIANCE MED PLAN |
| L016474 | Other | IL | TRICARE |
| 9866 | Other | IL | BLUE CROSS BLUE SHIELD HH |
Other names
- Memorial Home Health
Other providers in Springfield, IL
- Hailey Melvin
- Memorial Expresscare, LLC
- Memorial Health Partners
- Memorial Health Ventures
- Memorial Home Services
- Memorial Home Services of Central Illinois, Inc
- Memorial Medical Center
- Memorial Medical Center
- Memorial Medical Center
- Memorial Medical Center
All providers in Springfield, IL · Home Health Agency in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 30, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.