Provider Demographics
NPI:1801899950
Name:HOSPICE OF AMERICA, INC
Entity type:Organization
Organization Name:HOSPICE OF AMERICA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:630-682-3871
Mailing Address - Street 1:1N131 COUNTY FARM RD
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-2000
Mailing Address - Country:US
Mailing Address - Phone:630-682-3871
Mailing Address - Fax:
Practice Address - Street 1:1229 ARROWHEAD CT
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-8222
Practice Address - Country:US
Practice Address - Phone:219-661-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN022044251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200121780AMedicaid
IN200121780BMedicaid
IN200121780CMedicaid