Provider Demographics
NPI:1962477919
Name:PALOS COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:PALOS COMMUNITY HOSPITAL
Other - Org Name:PALOS COMMUNITY HOSPITAL HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOISAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-923-5000
Mailing Address - Street 1:15295 EAST 127TH STREET
Mailing Address - Street 2:PALOS COMMUNITY HOSPITAL HOSPICE
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-7405
Mailing Address - Country:US
Mailing Address - Phone:630-257-1111
Mailing Address - Fax:630-257-1461
Practice Address - Street 1:15295 EAST 127TH STREET
Practice Address - Street 2:PALOS COMMUNITY HOSPITAL HOSPICE
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-7405
Practice Address - Country:US
Practice Address - Phone:630-257-1111
Practice Address - Fax:630-257-1461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1652451251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14-1591Medicare ID - Type UnspecifiedHOSPICE #