Active NPI
V Care Hospice Services of Illinois, Inc.
- Community Based Hospice Care Agency
- Northbrook, IL
National Provider Identifier
1477839397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Based Hospice Care Agency
- Legal business name
- V CARE HOSPICE SERVICES OF ILLINOIS, INC.
- Practice address
- 3100 Dundee Rd
Suite 303
Northbrook, IL 60062-2459 - Phone
- (847) 272-5883
- Fax
- (847) 272-5884
- NPI assigned
- Oct 24, 2011
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Daniel Waters, RN
- Title
- President
- Phone
- (847) 272-5883
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Primary |
Addresses
Primary practice location
3100 Dundee Rd
Suite 303
Northbrook, IL 60062-2459
Mailing address
3100 Dundee Rd
Suite 303
Northbrook, IL 60062-2437
Phone (847) 272-5883
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2003069 | Other | IL | ILLINOIS DEPARTMENT OF PUBLIC HEALTH LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120815000219 | IL | Part A Provider - Hospice | 7618123217 | Practice locations: Northbrook, IL |
Hospice certification: CCN 141654
- Legal name
- V CARE HOSPICE SERVICES OF ILLINOIS INC
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Aug 7, 2013
- Last certification
- Aug 7, 2013
- Ownership / control type
- Proprietary - Corporation
- Organization structure
- Corporation
- Incorporated
- in IL
- Enrollment address
- 3100 Dundee Rd
Ste 303
Northbrook, IL 60062-2459
Care Compare: Hospice
Medicare Care Compare- Listed as
- V Care Hospice Services of Illinois
- Ownership
- For-Profit
- Certified
- Aug 7, 2013
- Medicare certification status
- Active
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D2032113 | V Care Hospice Services of Illinois Inc | Certificate of waiver | Nov 3, 2027 |
National Provider Directory
National Provider DirectoryLocations
3100 Dundee Rd
Ste 303
Northbrook, IL 60062
Phone (847) 272-5883
Ownership & related parties
All disclosed owners & managing parties 6
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Daniel Waters | Corporate Officer | Feb 1, 2011 | |
| Victor Svyatsky | Corporate Officer | Feb 1, 2011 | |
| Operational/Managerial Control | Feb 26, 2016 | ||
| Aiileen Betancourt-Ochoa | W-2 Managing Employee | Sep 12, 2022 | 33% |
| Rose Korol | 5% Or Greater Direct Ownership Interest | Feb 1, 2017 | |
| Carrie Luizzi | W-2 Managing Employee | May 9, 2016 | |
| Galina Waters | 5% Or Greater Direct Ownership Interest | Dec 30, 2010 |
Practitioners & affiliated clinicians
Affiliated clinicians 8
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1319414400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1456444800000",
"number": "1477839397",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3100 DUNDEE RD",
"address_2": "SUITE 303",
"city": "NORTHBROOK",
"state": "IL",
"postal_code": "600622437",
"telephone_number": "847-272-5883",
"fax_number": "847-272-5884"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3100 DUNDEE RD",
"address_2": "SUITE 303",
"city": "NORTHBROOK",
"state": "IL",
"postal_code": "600622459",
"telephone_number": "847-272-5883",
"fax_number": "847-272-5884"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "V CARE HOSPICE SERVICES OF ILLINOIS, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2011-10-24",
"last_updated": "2016-02-26",
"status": "A",
"authorized_official_last_name": "WATERS",
"authorized_official_first_name": "DANIEL",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "847-272-5883",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "RN"
},
"taxonomies": [
{
"code": "251G00000X",
"taxonomy_group": "",
"desc": "Hospice Care, Community Based",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ILLINOIS DEPARTMENT OF PUBLIC HEALTH LICENSE",
"identifier": "2003069",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Northbrook, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.