NPIMap

Organization Active NPI

Hospice of Kankakee Valley Palliative Clinic

  • Inpatient Hospice
  • Bourbonnais, IL
National Provider Identifier
1104906767
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Inpatient HospiceTaxonomy code 315D00000X
License
2000420 Issued in IL
Legal business name
HOSPICE OF KANKAKEE VALLEY PALLIATIVE CLINIC
Practice address
482 Main Street NW
Bourbonnais, IL 60914-2331
Phone
(815) 936-3370
Fax
(815) 936-3375
NPI assigned
Oct 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Dorothea M. Lagesse, MBA, HACP
Title
Executive Director
Phone
(815) 936-3370

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Inpatient Hospice 315D00000X 2000420 IL Primary

Addresses

Primary practice location

482 Main Street NW
Bourbonnais, IL 60914-2331

Mailing address

482 Main Street NW
Bourbonnais, IL 60914-2331
Phone (815) 936-3370

National Provider Directory

National Provider Directory
Tax ID family
Hospice of Kankakee Valley Palliative Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104906767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "482 MAIN STREET NW",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609142331",
            "telephone_number": "815-936-3370",
            "fax_number": "815-936-3375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "482 MAIN STREET NW",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609142331",
            "telephone_number": "815-936-3370",
            "fax_number": "815-936-3375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPICE OF KANKAKEE VALLEY PALLIATIVE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LAGESSE",
        "authorized_official_first_name": "DOROTHEA",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "815-936-3370",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MBA, HACP"
    },
    "taxonomies": [
        {
            "code": "315D00000X",
            "taxonomy_group": "",
            "desc": "Hospice, Inpatient",
            "state": "IL",
            "license": "2000420",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bourbonnais, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.