Healthcare Provider Details

I. General information

NPI: 1780853481
Provider Name (Legal Business Name): JOLIET AREA COMMUNITY HOSPICE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 WATER STONE CIR
JOLIET IL
60431-8313
US

IV. Provider business mailing address

250 WATER STONE CIR
JOLIET IL
60431-8313
US

V. Phone/Fax

Practice location:
  • Phone: 815-740-4104
  • Fax: 815-740-4107
Mailing address:
  • Phone: 815-740-4104
  • Fax: 815-740-4107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number2000339
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARY K SHEEHAN
Title or Position: CEO
Credential:
Phone: 815-740-4104