MEDICARE: GREAT LAKES CARING HOSPICE C IL, LLC

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

General Provider Information

NPI Number	:	1215391065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT LAKES CARING HOSPICE C IL, LLC

Provider Business Mailing Address
First Line	:	3010 LYNDON B JOHNSON FWY STE 1100
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75234-2712
Country	:	US
Telephone Number	:	800-379-1600
Fax Number	:	903-537-8420

Provider Business Practice Location Address
First Line	:	3085 STEVENSON DR STE 200A
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62703-4440
Country	:	US
Telephone Number	:	217-210-8457
Fax Number	:	217-679-2076

Authorized Official
Title or Position	:	DIR LICENSE & REGULATORY COMPLIANCE
Name	:	ANGEL STANSBURY
Credential	:
Telephone Number	:	337-344-2141

Provider Enumeration Date	:	04/07/2016
Last Update Date	:	02/05/2026

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