Provider Demographics
NPI:1407919293
Name:HOSPICE OF THE CALUMET AREA, INC.
Entity Type:Organization
Organization Name:HOSPICE OF THE CALUMET AREA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ADRIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-895-8332
Mailing Address - Street 1:3224 RIDGE RD
Mailing Address - Street 2:SUITE 202 & 203
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-3129
Mailing Address - Country:US
Mailing Address - Phone:708-895-8332
Mailing Address - Fax:219-922-1947
Practice Address - Street 1:3224 RIDGE RD
Practice Address - Street 2:SUITE 202 & 203
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-3129
Practice Address - Country:US
Practice Address - Phone:708-895-8332
Practice Address - Fax:219-922-2732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2001006251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL141529Medicare ID - Type UnspecifiedHOSPICE