Provider Demographics
NPI:1154175511
Name:GRACE HOSPICE & PALLIATIVE CARE INC
Entity type:Organization
Organization Name:GRACE HOSPICE & PALLIATIVE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:E GEOVANNI
Authorized Official - Middle Name:
Authorized Official - Last Name:IZURIETA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-634-0086
Mailing Address - Street 1:10220 S CICERO AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-4086
Mailing Address - Country:US
Mailing Address - Phone:708-634-0086
Mailing Address - Fax:708-634-0016
Practice Address - Street 1:10220 S CICERO AVE STE 202
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4086
Practice Address - Country:US
Practice Address - Phone:708-634-0086
Practice Address - Fax:708-634-0016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based