=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629868906
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAFE LIFE PALLIATIVE AND HOSPICE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2025
-----------------------------------------------------
Last Update Date | 05/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 W 22ND ST STE 202
-----------------------------------------------------
City | LOMBARD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60148-4989
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-620-9064
-----------------------------------------------------
Fax | 630-406-9342
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 W 22ND ST STE 202
-----------------------------------------------------
City | LOMBARD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60148-4989
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-620-9064
-----------------------------------------------------
Fax | 630-406-9342
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | SHAHMIR MOHAMMED
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 630-620-9064
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------