Suncrest Hospice Illinois LLC
Organization Active NPI Community Based Hospice Care Agency · Northbrook, IL
NPI 1003340050 · NPPES record last updated Jul 1, 2026
Key facts
- NPI
- 1003340050
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- Legal business name
- SUNCREST HOSPICE ILLINOIS LLC
- Practice address
- 5 Revere Dr Ste 130
Northbrook, IL 60062-8004 - Phone
- (847) 983-0017
- NPI assigned
- Apr 17, 2017
- Organization subpart
- Yes
- Parent organization (as reported)
- SUNCREST HEALTH SERVICES LLC
Authorized official
- Name
- Christopher Harris
- Title
- Ceo
- Phone
- (801) 849-0486
Owners & managing parties with NPI records 2
-
Kenneth Breger, MD
Facilities with the same owner 40
Practitioners 1
-
Kenneth Breger, MD
Affiliated clinicians 104
-
Jibran Ahmed, M.D.
-
Wahaj Ahmed, M.D.
-
Mansoor Ali, MD
-
Lawrence Amato, M.D.
-
Andrea Arias, APN
-
Jean Athappilly, APRN AGPCNP
-
Katarzyna Barnes, APN
-
Percival A Bigol, MD
-
Christine L. Bollier, APN-CNP
-
John R Born, DO
-
Jasdip Singh Brar, M.D.
-
Kenneth Breger, MD
-
Eric J Chuang, M.D.
-
Thomas F Cozzi, MD
-
Godwin H D'Souza, M.D.
-
Anthony W. Delorenzo, D.O.
-
Adrian W Deme, MD
-
Erin Beth Dominiak, M.D.
Medicare Care Compare: Hospice
- Listed as
- Suncrest Hospice Illinois LLC
- Ownership
- For-Profit
- Certified
- Jan 1, 2018
- Medicare certification status
- Active
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D2133761 | Suncrest Hospice Illinois | Certificate of waiver | Jul 18, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Hospice certification: CCN 141696
- Legal name
- SUNCREST HOSPICE ILLINOIS LLC
- Doing business as
- SUNCREST HOSPICE
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Jan 1, 2018
- Last certification
- Jan 1, 2018
- Ownership / control type
- Proprietary - Other
- Organization structure
- LLC · Proprietary
- Incorporated
- Nov 23, 2016 in UT
- Enrollment address
- 5 Revere Dr
Ste 130
Northbrook, IL 60062-8004
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Marek J Grzeskowiak |
W-2 Managing Employee |
Oct 20, 2025 | |
| Scott David Perucca |
5% Or Greater Indirect Ownership Interest | Jan 3, 2024 | 34.2% |
| Corporate Officer |
Nov 23, 2016 | 34.2% | |
| Operational/Managerial Control |
Nov 23, 2016 | 34.2% | |
| Christopher Jay Harris |
5% Or Greater Indirect Ownership Interest |
Jan 3, 2024 | 5% |
| Corporate Officer |
Jan 3, 2022 | 5% | |
| Erin M Bennett |
5% Or Greater Indirect Ownership Interest | Jan 3, 2024 | 13.3% |
| Tyler M Godfrey |
5% Or Greater Indirect Ownership Interest | Jan 3, 2024 | 34.2% |
| Corporate Officer |
Nov 23, 2016 | 34.2% | |
| Operational/Managerial Control |
Nov 23, 2016 | 34.2% | |
| Kenneth M Breger |
Contracted Managing Employee |
Jan 1, 2024 | 100% |
| Thomas B Godfrey |
5% Or Greater Indirect Ownership Interest | Jan 3, 2024 | 13.3% |
| Suncrest Health Services LLC |
5% Or Greater Direct Ownership Interest | Nov 23, 2016 | 100% |
| Sarah Eileen Nielsen |
W-2 Managing Employee |
Jan 3, 2024 | |
| G&B Newco Inc |
5% Or Greater Indirect Ownership Interest | Jan 3, 2024 | 26.6% |
| Dawn Anderson |
W-2 Managing Employee |
Jan 1, 2024 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20171130000467 | IL | Part a Provider - Hospice | 1254698293 | Practice locations: Northbrook, IL; Westmont, IL |
National Provider Directory
Locations
5 Revere Dr
Ste 130
Northbrook, IL 60062
Phone (847) 983-0017
777 Oakmont Ln
Ste 1400
Westmont, IL 60559
Phone (630) 743-6477
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Yes |
Addresses
Primary practice location
5 Revere Dr Ste 130
Northbrook, IL 60062-8004
Mailing address
9800 S Monroe St Ste 900
Sandy, UT 84070-4419
Phone (801) 849-0486
Other names
- Suncrest Hospice
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | tosborne@suncrestcare.com |
Other providers in Northbrook, IL
- Suh New Hope Clinics,LTD.
- Savannah Mae Sullivan
- Jennifer Lee Summers-Lemoine
- Nicole Summers
- Suncloud Health
- Debra Clare Sundblad
- Sunshine Infusion Services Inc
- Klara Suparman
- Ishaan Sura
- Bess Surmenkow
All providers in Northbrook, IL · Community Based Hospice Care Agency in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 1, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.