Provider Demographics
NPI:1497314371
Name:MEDI-PLEX HOSPICE OF ILLINOIS, LLC
Entity Type:Organization
Organization Name:MEDI-PLEX HOSPICE OF ILLINOIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, BSN, RN
Authorized Official - Phone:618-416-6900
Mailing Address - Street 1:8 PARK PLACE
Mailing Address - Street 2:SUITE #3
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226
Mailing Address - Country:US
Mailing Address - Phone:618-416-6900
Mailing Address - Fax:618-416-6902
Practice Address - Street 1:8 PARK PLACE
Practice Address - Street 2:SUITE #3
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226
Practice Address - Country:US
Practice Address - Phone:618-416-6900
Practice Address - Fax:618-416-6902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH1000XNursing Service ProvidersRegistered NurseHospiceGroup - Multi-Specialty