Provider Demographics
NPI:1891164554
Name:RESIDENTIAL HOSPICE ILLINOIS, LLC
Entity Type:Organization
Organization Name:RESIDENTIAL HOSPICE ILLINOIS, LLC
Other - Org Name:RESIDENTIAL HOSPICE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEWITTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-283-8839
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:866-902-5854
Mailing Address - Fax:866-903-4000
Practice Address - Street 1:2443 WARRENVILLE RD STE 500
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-4356
Practice Address - Country:US
Practice Address - Phone:855-902-5100
Practice Address - Fax:866-996-0082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-23
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty