MEDICARE: HOSPICE SANCTUARY OF ILLINOIS 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	:	1962741439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPICE SANCTUARY OF ILLINOIS LLC

Provider Business Mailing Address
First Line	:	3101 N CALIFORNIA AVE
Second Line	:	SUITE 1N
City	:	CHICAGO
State	:	IL
Zip	:	60618-7007
Country	:	US
Telephone Number	:	602-330-3000
Fax Number	:	773-267-5501

Provider Business Practice Location Address
First Line	:	3101 N CALIFORNIA AVE
Second Line	:	SUITE 1N
City	:	CHICAGO
State	:	IL
Zip	:	60618-7007
Country	:	US
Telephone Number	:	602-330-3000
Fax Number	:	773-267-5501

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DANIEL ARDELEAN
Credential	:
Telephone Number	:	602-330-3000

Provider Enumeration Date	:	02/04/2013
Last Update Date	:	02/04/2013

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