Provider Demographics
NPI:1689099848
Name:BEACON OF HOPE HOSPICE OF ILLINOIS
Entity Type:Organization
Organization Name:BEACON OF HOPE HOSPICE OF ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SULZBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:314-815-3500
Mailing Address - Street 1:2191 LEMAY FERRY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125-2408
Mailing Address - Country:US
Mailing Address - Phone:314-815-3500
Mailing Address - Fax:
Practice Address - Street 1:102 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-4601
Practice Address - Country:US
Practice Address - Phone:309-344-4673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-25
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based