MEDICARE: TRINITY HOSPICE OF CHICAGO, 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	:	1700913415
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY HOSPICE OF CHICAGO, LLC

Provider Business Mailing Address
First Line	:	14180 DALLAS PKWY
Second Line	:	SUITE 800
City	:	DALLAS
State	:	TX
Zip	:	75254-4341
Country	:	US
Telephone Number	:	214-306-4520
Fax Number	:	214-853-5864

Provider Business Practice Location Address
First Line	:	85 W ALGONQUIN RD
Second Line	:	SUITE 100
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-4422
Country	:	US
Telephone Number	:	847-357-0557
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	AMY M GLASSCOCK
Credential	:
Telephone Number	:	214-306-4520

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	08/23/2007

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