Provider Demographics
NPI:1285268326
Name:ELYSIAN HOSPICE, INC
Entity type:Organization
Organization Name:ELYSIAN HOSPICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CFO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:W
Authorized Official - Last Name:HIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-699-4715
Mailing Address - Street 1:111 W WASHINGTON ST STE 310
Mailing Address - Street 2:
Mailing Address - City:EAST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61611-2559
Mailing Address - Country:US
Mailing Address - Phone:309-699-4715
Mailing Address - Fax:309-699-4717
Practice Address - Street 1:111 W WASHINGTON ST STE 310
Practice Address - Street 2:
Practice Address - City:EAST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61611-2559
Practice Address - Country:US
Practice Address - Phone:309-699-4715
Practice Address - Fax:309-699-4717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1295960847OtherNPI