MEDICARE: MONARCH HOSPICE AND PALLIATIVE CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	2003122	IL

General Provider Information

NPI Number	:	1093258824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONARCH HOSPICE AND PALLIATIVE CARE

Provider Business Mailing Address
First Line	:	7444 W WILSON AVE # 201
Second Line	:
City	:	HARWOOD HEIGHTS
State	:	IL
Zip	:	60706-4549
Country	:	US
Telephone Number	:	847-885-1818
Fax Number	:	708-695-5030

Provider Business Practice Location Address
First Line	:	7444 W WILSON AVE # 201
Second Line	:
City	:	HARWOOD HEIGHTS
State	:	IL
Zip	:	60706-4549
Country	:	US
Telephone Number	:	847-885-1818
Fax Number	:	708-695-5030

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ELLY LATINIK
Credential	:
Telephone Number	:	847-885-1818

Provider Enumeration Date	:	11/28/2016
Last Update Date	:	11/28/2016

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