Provider Demographics
NPI:1477839397
Name:V CARE HOSPICE SERVICES OF ILLINOIS, INC.
Entity Type:Organization
Organization Name:V CARE HOSPICE SERVICES OF ILLINOIS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:847-272-5883
Mailing Address - Street 1:3100 DUNDEE RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2437
Mailing Address - Country:US
Mailing Address - Phone:847-272-5883
Mailing Address - Fax:847-272-5884
Practice Address - Street 1:3100 DUNDEE RD
Practice Address - Street 2:SUITE 303
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2459
Practice Address - Country:US
Practice Address - Phone:847-272-5883
Practice Address - Fax:847-272-5884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-24
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2003069OtherILLINOIS DEPARTMENT OF PUBLIC HEALTH LICENSE
141654Medicare Oscar/Certification