MEDICARE: MOMENTS HOSPICE OF CHICAGO NORTH 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	:	1659972727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOMENTS HOSPICE OF CHICAGO NORTH LLC

Provider Business Mailing Address
First Line	:	820 LILAC DR N STE 210
Second Line	:
City	:	GOLDEN VALLEY
State	:	MN
Zip	:	55422-4754
Country	:	US
Telephone Number	:	612-655-5242
Fax Number	:

Provider Business Practice Location Address
First Line	:	2860 S RIVER RD STE 160
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60018-6006
Country	:	US
Telephone Number	:	877-666-3687
Fax Number	:	763-205-3600

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ELIYAHU JAFFA
Credential	:
Telephone Number	:	715-800-0908

Provider Enumeration Date	:	11/05/2020
Last Update Date	:	09/21/2023

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