Provider Demographics
NPI:1780853481
Name:JOLIET AREA COMMUNITY HOSPICE CORPORATION
Entity Type:Organization
Organization Name:JOLIET AREA COMMUNITY HOSPICE CORPORATION
Other - Org Name:JOLIET AREA COMMUNITY HOSPICE PALLIATIVE CARE SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-740-4104
Mailing Address - Street 1:250 WATER STONE CIR
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-8313
Mailing Address - Country:US
Mailing Address - Phone:815-740-4104
Mailing Address - Fax:815-740-4107
Practice Address - Street 1:250 WATER STONE CIR
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-8313
Practice Address - Country:US
Practice Address - Phone:815-740-4104
Practice Address - Fax:815-740-4107
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOLIET AREA COMMUNITY HOSPICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-27
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2000339207QH0002X
207QH0002X, 363L00000X, 363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILNONEOtherBCBSIL