Provider Demographics
NPI:1578975744
Name:RESIDENTIAL HOSPICE ILLINOIS, LLC
Entity Type:Organization
Organization Name:RESIDENTIAL HOSPICE ILLINOIS, LLC
Other - Org Name:RESIDENTIAL HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP COMPLIANCE & QUALITY
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:EULBERG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:630-219-1664
Mailing Address - Street 1:5440 CORPORATE DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-2646
Mailing Address - Country:US
Mailing Address - Phone:855-902-5100
Mailing Address - Fax:866-903-4000
Practice Address - Street 1:5440 CORPORATE DR
Practice Address - Street 2:SUITE 400
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-2646
Practice Address - Country:US
Practice Address - Phone:855-902-5100
Practice Address - Fax:866-903-4000
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RESIDENTIAL HOSPICE ILLINOIS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2003114251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL141577OtherMEDICARE PTAN