Healthcare Provider Details

I. General information

NPI: 1811935240
Provider Name (Legal Business Name): HOSPICE OF KANKAKEE VALLEY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 03/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

482 MAIN ST NW
BOURBONNAIS IL
60914-2331
US

IV. Provider business mailing address

482 MAIN ST NW
BOURBONNAIS IL
60914-2331
US

V. Phone/Fax

Practice location:
  • Phone: 815-939-4141
  • Fax: 815-936-3375
Mailing address:
  • Phone: 815-939-4141
  • Fax: 815-936-3375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number036-099237
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number2000420
License Number StateIL

VIII. Authorized Official

Name: MR. JAMES K TURNER
Title or Position: EXECUTIVE DIRECTOR
Credential: MBA CPA
Phone: 815-939-4141