MEDICARE: A TOUCH OF GRACE HOSPICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	1688275	IL

General Provider Information

NPI Number	:	1063467561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A TOUCH OF GRACE HOSPICE

Provider Business Mailing Address
First Line	:	1033 W VAN BUREN ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-2972
Country	:	US
Telephone Number	:	312-733-2317
Fax Number	:	312-733-2392

Provider Business Practice Location Address
First Line	:	1033 W VAN BUREN ST, STE 705
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-2972
Country	:	US
Telephone Number	:	312-733-2317
Fax Number	:	312-733-2392

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JENNIFER D MOORE
Credential	:
Telephone Number	:	312-733-2317

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	08/22/2020

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