Provider Demographics
NPI:1407467509
Name:SHILOH HOSPICE & PALLIATIVE CARE, LLC
Entity Type:Organization
Organization Name:SHILOH HOSPICE & PALLIATIVE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BABATUNDE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEOSUN
Authorized Official - Suffix:
Authorized Official - Credentials:APN, FNP-C, CRNA
Authorized Official - Phone:773-886-6894
Mailing Address - Street 1:603 E 170TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-3408
Mailing Address - Country:US
Mailing Address - Phone:773-886-6894
Mailing Address - Fax:
Practice Address - Street 1:603 E 170TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-3408
Practice Address - Country:US
Practice Address - Phone:708-705-5841
Practice Address - Fax:708-575-3400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-12
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2003186OtherILLINOIS HOSPICE LICENSE