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General NPI Number Information
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NPI Number | 1063266716
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Entity Type | Organization
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Legal Business Name | TOWN SQUARE HOSPICE ILLINOIS LLC
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Dates
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Enumeration Date | 04/17/2024
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 112 W WASHINGTON ST STE 2B
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City | MONTICELLO
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State | IL
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Zip | 61856-1668
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Country | US
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Telephone | 217-670-6990
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Fax | 217-606-7938
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Provider Business Mailing Address
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Address Line | 112 W WASHINGTON ST STE 2B
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City | MONTICELLO
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State | IL
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Zip | 61856-1668
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Country | US
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Telephone | 217-670-6990
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Fax | 217-606-7938
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Authorized Official
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Title or Position | CHAIRMAN OF THE BOARD
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Name | MICHAEL WIK
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Credential |
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Telephone | 330-588-3803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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