=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598454332
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACACIA HOSPICE AND PALLIATIVE CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2023
-----------------------------------------------------
Last Update Date | 05/08/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2200 SOUTH MAIN STREET STE 304
-----------------------------------------------------
City | LOMBARD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60148-5366
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-613-8946
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2200 SOUTH MAIN STREET STE 304
-----------------------------------------------------
City | LOMBARD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60148-5366
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-613-8946
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | LEOVIGILDO C JABONI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 312-731-1498
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------