Provider Demographics
NPI:1063467561
Name:A TOUCH OF GRACE HOSPICE
Entity Type:Organization
Organization Name:A TOUCH OF GRACE HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-733-2317
Mailing Address - Street 1:1033 W VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2972
Mailing Address - Country:US
Mailing Address - Phone:312-733-2317
Mailing Address - Fax:312-733-2392
Practice Address - Street 1:1033 W VAN BUREN ST, STE 705
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2972
Practice Address - Country:US
Practice Address - Phone:312-733-2317
Practice Address - Fax:312-733-2392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1688275251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL141623Medicare ID - Type UnspecifiedPROVIDER NUMBER