Healthcare Provider Details

I. General information

NPI: 1023716875
Provider Name (Legal Business Name): IHCC HOSPICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 N MAIN ST
PRINCETON IL
61356-1329
US

IV. Provider business mailing address

602 N MAIN ST
PRINCETON IL
61356-1329
US

V. Phone/Fax

Practice location:
  • Phone: 815-872-7447
  • Fax: 855-356-4048
Mailing address:
  • Phone: 815-872-7447
  • Fax: 855-356-4048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084H0002X
TaxonomyHospice and Palliative Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY PARK
Title or Position: OWNER
Credential:
Phone: 815-872-7447