Healthcare Provider Details

I. General information

NPI: 1497895569
Provider Name (Legal Business Name): VITAS HEALTHCARE CORPORATION OF ILLINOIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 12/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 WATERS EDGE SUITE 100
LOMBARD IL
60148-6430
US

IV. Provider business mailing address

3046 CORPORATE WAY
MIRAMAR FL
33025-6547
US

V. Phone/Fax

Practice location:
  • Phone: 630-495-8484
  • Fax: 630-495-1598
Mailing address:
  • Phone: 305-374-4143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number2002145
License Number StateIL

VIII. Authorized Official

Name: NICHOLAS WESTFALL
Title or Position: CEO
Credential:
Phone: 305-374-4143