Provider Demographics
NPI:1811011919
Name:MIDWEST PALLIATIVE & HOSPICE CARECENTER
Entity Type:Organization
Organization Name:MIDWEST PALLIATIVE & HOSPICE CARECENTER
Other - Org Name:HOMECARE OF MIDWEST
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-467-7423
Mailing Address - Street 1:2050 CLAIRE CT
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-7635
Mailing Address - Country:US
Mailing Address - Phone:847-467-7423
Mailing Address - Fax:847-556-1611
Practice Address - Street 1:2050 CLAIRE CT
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-7635
Practice Address - Country:US
Practice Address - Phone:847-467-7423
Practice Address - Fax:847-556-1611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL001006089251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1811011919OtherMEDICAL HOME VISITS
ILCJ8679OtherMEDICARE RAILROAD
ILCJ8679OtherMEDICARE RAILROAD
IL200407Medicare ID - Type UnspecifiedMHV PHY COOK CTY GRP#
IL=========003Medicaid
ILCJ8679OtherMEDICARE RAILROAD
IL1811011919OtherMEDICAL HOME VISITS
IL740710Medicare ID - Type UnspecifiedAPN - COOK CTY GROUP#
IL204892Medicare ID - Type UnspecifiedDIET,NUTR - LAKE CTY GRP#
IL200994Medicare ID - Type UnspecifiedCSW - LAKE CTY GROUP#
IL204893Medicare ID - Type UnspecifiedDIET,NUTR - COOK CTY GRP#
IL200408Medicare ID - Type UnspecifiedMHV PHY LAKE CTY GRP#