NPIMap

Organization Active NPI

Rest Haven Illiana Christian Convalescent Home

Doing business as Providence Hospice

  • Community Based Hospice Care Agency
  • Saint John, IN
National Provider Identifier
1548614910
Registry record updated May 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
REST HAVEN ILLIANA CHRISTIAN CONVALESCENT HOME
Doing business as
Providence Hospice
Providence Life Services
Practice address
10700 Park PL
Saint John, IN 46373-8666
Phone
(800) 509-2800
Fax
(708) 342-8006
NPI assigned
Apr 21, 2016
Last updated
May 26, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2026

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

Authorized official

Name
Johanna Zandstra
Title
Vice President of Operations
Phone
(708) 342-8100

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X NU Primary
Hospice and Palliative Medicine (Internal Medicine) Physician 207RH0002X NU

Addresses

Primary practice location

10700 Park PL
Saint John, IN 46373-8666

Mailing address

18601 N Creek Dr
Tinley Park, IL 60477-6397
Phone (708) 342-8100

Other names 2

  • Providence Hospice Doing business as
  • Providence Life Services Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160826000379 IN Part A Provider - Hospice 1052221470 Practice locations: Saint John, IN
O20200713001575 IN Part B Supplier - Clinic/Group Practice 1052221470 Receives reassigned benefits from 2 practitioners
Practice locations: Saint John, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1548614910. Details of each certification follow.

Hospice certification: CCN 151624

Legal name
REST HAVEN ILLIANA CHRISTIAN CONVALESCENT HOME
Doing business as
PROVIDENCE HOSPICE, INC.
Certification status
Active
Provider type (POS)
Hospice
Participating since
Aug 28, 2017
Last certification
Aug 28, 2017
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 6, 1956 in IL
Enrollment address
10700 Park PL
Saint John, IN 46373-8666

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospice

Medicare Care Compare
Listed as
Providence Hospice, IncCCN 151624 · All quality measures
Ownership
Non-Profit
Certified
Aug 28, 2017
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
15D2120856Providence Hospice, Inc10700 Park Place, St John, IN 46373Certificate of waiverOct 25, 2026

National Provider Directory

National Provider Directory
Tax ID family
Rest Haven Central4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

18601 North Creek Dr
Ste A
Tinley Park, IL 60477
Phone (708) 557-6527

18670 Graphics Dr
Ste 106
Tinley Park, IL 60477

7725 Broadway
Ste D
Merrillville, IN 46410
Phone (219) 736-0348

8929 Broadway
Merrillville, IN 46410
Phone (708) 342-8100

10033 Wicker Ave
Ste 10
Saint John, IN 46373
Phone (219) 365-3229

Ownership & related parties

All disclosed owners & managing parties 19

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kenneth Alan Hoving Individual Corporate DirectorAsst. Secretary/Treasurer Apr 2, 2022
Rest Haven Illiana Christian Convalescent Home Organization, Tinley Park, IL Non-profit 5% Or Greater Direct Ownership Interest Jun 15, 2016 100%
Johanna Zandstra Individual Operational/Managerial Control Apr 28, 2016
Darren Van Essen Individual Corporate Director Apr 2, 2022
Paul Buikema Individual Corporate Director Apr 2, 2022
Paul Kats Individual Corporate DirectorChair Apr 2, 2022
Theodore Earle Feenstra Individual Corporate Director Apr 2, 2022
Edward Damstra Individual Corporate Director Apr 2, 2022
Jacob J Groenewold Individual Corporate DirectorSecretary/Treasurer Apr 2, 2022
Roger Boerema Individual Corporate DirectorVice Chair Apr 2, 2022
Barry Vandergenugten Individual Operational/Managerial Control Apr 28, 2016
David Voss Individual Corporate Director Apr 2, 2022
Sheryl Hammer Individual Corporate Director Apr 2, 2022
Karen Huizenga Individual Corporate Director Apr 2, 2022
Emily McMaster Individual Corporate Director Apr 2, 2022
William Zandstra Individual Corporate Director Apr 28, 2016
Kyle Yonker Individual Corporate Director Apr 2, 2022
Patricia L Jabaay Individual Corporate Director Apr 2, 2022
Amy Mosoriak Individual W-2 Managing Employee Feb 7, 2020

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Park Place Christian CommunityElmhurst, IL, CCN 146155 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Adp of the SNF		 May 5, 2004
Aug 23, 2012
Providence Life ServicesHomer Glen, IL, CCN 146178 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Adp of the SNF		 Jan 26, 2015
Jan 26, 2015
Rest Haven Illiana Christian Convalescent HomeHomer Glen, IL, CCN 147559 Home health agency 5% Or Greater Direct Ownership Interest (100%) Mar 30, 1994
Providence HospiceHomer Glen, IL, CCN 141609 Hospice 5% Or Greater Direct Ownership Interest (100%) Feb 10, 2003

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 6

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": "1461196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779753600000",
    "number": "1548614910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18601 N CREEK DR",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604776397",
            "telephone_number": "708-342-8100",
            "fax_number": "708-342-8006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10700 PARK PL",
            "city": "SAINT JOHN",
            "state": "IN",
            "postal_code": "463738666",
            "telephone_number": "800-509-2800",
            "fax_number": "708-342-8006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REST HAVEN ILLIANA CHRISTIAN CONVALESCENT HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-21",
        "last_updated": "2026-05-26",
        "certification_date": "2026-05-26",
        "status": "A",
        "authorized_official_last_name": "ZANDSTRA",
        "authorized_official_first_name": "JOHANNA",
        "authorized_official_title_or_position": "VICE PRESIDENT OF OPERATIONS",
        "authorized_official_telephone_number": "708-342-8100"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RH0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Hospice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence Life Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint John, IN

Sources for this page

Verify at the official NPI Registry.