MEDICARE: SILVERADO HOSPICE OF ILLINOIS INC

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	:	1285151449
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILVERADO HOSPICE OF ILLINOIS INC

Provider Business Mailing Address
First Line	:	1175 CENTRE POINTE CIR
Second Line	:
City	:	MENDOTA HEIGHTS
State	:	MN
Zip	:	55120-5500
Country	:	US
Telephone Number	:	651-328-6934
Fax Number	:

Provider Business Practice Location Address
First Line	:	11741 A SOUTHWEST HWY
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1015
Country	:	US
Telephone Number	:	847-565-2355
Fax Number	:

Authorized Official
Title or Position	:	CFO AND PRESIDENT
Name	:	STEPHEN PHENNEGER
Credential	:
Telephone Number	:	612-544-6133

Provider Enumeration Date	:	08/28/2017
Last Update Date	:	05/27/2026

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