Provider Demographics
NPI:1033354980
Name:GUIDING LIGHT HOSPICE LLC
Entity Type:Organization
Organization Name:GUIDING LIGHT HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:815-830-7499
Mailing Address - Street 1:2285 US ROUTE 52
Mailing Address - Street 2:PO BOX 124
Mailing Address - City:SERENA
Mailing Address - State:IL
Mailing Address - Zip Code:60549-5105
Mailing Address - Country:US
Mailing Address - Phone:815-830-7499
Mailing Address - Fax:
Practice Address - Street 1:2285 US ROUTE 52 # 124
Practice Address - Street 2:
Practice Address - City:SERENA
Practice Address - State:IL
Practice Address - Zip Code:60549-5105
Practice Address - Country:US
Practice Address - Phone:815-830-7499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-06
Last Update Date:2008-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILAPPLIED FOR251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based