Provider Demographics
NPI:1497895569
Name:VITAS HEALTHCARE CORPORATION OF ILLINOIS
Entity Type:Organization
Organization Name:VITAS HEALTHCARE CORPORATION OF ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTFALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-374-4143
Mailing Address - Street 1:3046 CORPORATE WAY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-6547
Mailing Address - Country:US
Mailing Address - Phone:305-374-4143
Mailing Address - Fax:
Practice Address - Street 1:580 WATERS EDGE
Practice Address - Street 2:SUITE 100
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-6430
Practice Address - Country:US
Practice Address - Phone:630-495-8484
Practice Address - Fax:630-495-1598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2002145251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002Medicaid
IL=========002Medicaid
IL141514Medicare Oscar/Certification