Provider Demographics
NPI:1073696456
Name:GOOD HEART HOSPICE, INC.
Entity Type:Organization
Organization Name:GOOD HEART HOSPICE, INC.
Other - Org Name:HOPE PALLIATIVE AND HOSPICE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANULFO
Authorized Official - Middle Name:S
Authorized Official - Last Name:VIZCARRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-502-9670
Mailing Address - Street 1:1272 W NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-1897
Mailing Address - Country:US
Mailing Address - Phone:847-803-0400
Mailing Address - Fax:847-803-0499
Practice Address - Street 1:1272 W NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-1897
Practice Address - Country:US
Practice Address - Phone:847-803-0400
Practice Address - Fax:847-803-0499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-22
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1764085251G00000X
IL2002996251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL141627Medicare Oscar/Certification
141627Medicare Oscar/Certification