Provider Demographics
NPI:1043212103
Name:JOLIET AREA COMMUNITY HOSPICE CORPORATION
Entity Type:Organization
Organization Name:JOLIET AREA COMMUNITY HOSPICE CORPORATION
Other - Org Name:LIGHTWAYS HOSPICE AND SERIOUS ILLNESS CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-740-4104
Mailing Address - Street 1:250 WATER STONE CIR
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-8313
Mailing Address - Country:US
Mailing Address - Phone:815-740-4104
Mailing Address - Fax:815-740-4107
Practice Address - Street 1:250 WATER STONE CIR
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-8313
Practice Address - Country:US
Practice Address - Phone:815-740-4104
Practice Address - Fax:815-740-4107
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOLIET AREA COMMUNITY HOSPICE PALLIATIVE CARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-02
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0722000339251G00000X
IL0722000340315D00000X
363L00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251G00000XAgenciesHospice Care, Community Based
No315D00000XNursing & Custodial Care FacilitiesHospice, InpatientGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL103501032395OtherHUMANA
IL0004423721OtherAETNA
9518OtherBCBS OF IL
IL103501032395OtherHUMANA