Organization
FAYETTE COUNTY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RHONDA ANDREWS (ADMINISTRATOR)
(618) 283-1044
Entity
Organization
Contact information
Practice address
416 W EDWARDS ST, VANDALIA, IL 62471-2706
(618) 283-7262
(618) 283-5039
Mailing address
416 W EDWARDS ST, VANDALIA, IL 62471-2706
(618) 283-1044
(618) 283-5038
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
1625062
IL
251G00000X
Community Based Hospice Care Agency
1863108
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
136947
HEALTH LINK
IL
01
—
50364
BC/BS HOSPICE
IL
01
—
9819
BC/BS
IL
Enumeration date
07/22/2005
Last updated
02/02/2017
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