Healthcare Provider Details

I. General information

NPI: 1700884731
Provider Name (Legal Business Name): NORTHERN ILLINOIS HOSPICE ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4751 HARRISON AVE
ROCKFORD IL
61108-7929
US

IV. Provider business mailing address

4751 HARRISON AVE
ROCKFORD IL
61108-7929
US

V. Phone/Fax

Practice location:
  • Phone: 815-398-0500
  • Fax: 815-398-0588
Mailing address:
  • Phone: 815-398-0500
  • Fax: 815-398-0588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number2000313
License Number StateIL

VIII. Authorized Official

Name: MS. LISA J NOVAK
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 815-398-0500