1043212103 NPI number — JOLIET AREA COMMUNITY HOSPICE CORPORATION

Table of content: (NPI 1043212103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043212103 NPI number — JOLIET AREA COMMUNITY HOSPICE CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOLIET AREA COMMUNITY HOSPICE CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LIGHTWAYS HOSPICE AND SERIOUS ILLNESS CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043212103
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 WATER STONE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOLIET
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60431-8313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-740-4104
Provider Business Mailing Address Fax Number:
815-740-4107

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 WATER STONE CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOLIET
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60431-8313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-740-4104
Provider Business Practice Location Address Fax Number:
815-740-4107
Provider Enumeration Date:
06/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SHEEHAN
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
815-740-4104

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  0722000339 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 315D00000X , with the licence number: 0722000340 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 103501032395 . This is a "HUMANA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0004423721 . This is a "AETNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 9518 . This is a "BCBS OF IL" identifier . This identifiers is of the category "OTHER".




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