Provider Demographics
NPI:1811745730
Name:DOVER HOSPICE IL CHICAGO METRO, LLC
Entity type:Organization
Organization Name:DOVER HOSPICE IL CHICAGO METRO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF HOSPICE
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:573-760-3730
Mailing Address - Street 1:300 HUNTER AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-2328
Mailing Address - Country:US
Mailing Address - Phone:314-884-8817
Mailing Address - Fax:
Practice Address - Street 1:350 HOUBOLT RD STE 209A
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-8305
Practice Address - Country:US
Practice Address - Phone:573-760-3730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based