Provider Demographics
NPI:1073057691
Name:ADVOCATE AT HOME
Entity Type:Organization
Organization Name:ADVOCATE AT HOME
Other - Org Name:ADVOCATE HOSPICE
Other - Org Type:Other Name
Authorized Official - Title/Position:HOSPICE SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:ALIDA
Authorized Official - Last Name:KILLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:309-268-2055
Mailing Address - Street 1:303 N HERSHEY RD STE C
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-7748
Mailing Address - Country:US
Mailing Address - Phone:309-268-2025
Mailing Address - Fax:309-268-5960
Practice Address - Street 1:303 N HERSHEY RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-3576
Practice Address - Country:US
Practice Address - Phone:309-268-2025
Practice Address - Fax:309-268-5960
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVOCATE HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-16
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.006287251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based