Organization Active NPI

Quality of Life Hospice & Palliative Care LLC

  • Community Based Hospice Care Agency
  • Oak Lawn, IL
National Provider Identifier
1609554823
Registry record updated Jul 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
QUALITY OF LIFE HOSPICE & PALLIATIVE CARE LLC
Practice address
4550 W 103Rd St Ste 301D
Oak Lawn, IL 60453-4868
Phone
(708) 996-5898
NPI assigned
Jul 7, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2023

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

Authorized official

Name
Ronya Johnson
Title
Member
Phone
(708) 996-5898

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

4550 W 103Rd St Ste 301D
Oak Lawn, IL 60453-4868

Mailing address

4550 W 103Rd St Ste 301D
Oak Lawn, IL 60453-4868
Phone (708) 996-5898

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230831002955 IL Part A Provider - Hospice 9638532062 Practice locations: Orland Park, IL

Hospice certification: CCN 141738

Legal name
QUALITY OF LIFE HOSPICE & PALLIATIVE CARE LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Aug 5, 2024
Last certification
Aug 1, 2024
Ownership / control type
Proprietary - Corporation
Organization structure
LLCProprietary
Incorporated
Dec 1, 2021 in IL
Enrollment address
15255 South 94TH Ave
Ste 500 Unit 552
Orland Park, IL 60462

Care Compare: Hospice

Medicare Care Compare
Listed as
Quality of Life Hospice & Palliative Care LLCCCN 141738
Certified
Aug 5, 2024
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Ronya Johnson Individual 5% Or Greater Direct Ownership InterestDirector Jan 1, 2023 50%
Corporate OfficerDirector Jan 1, 2023 50%
Corporate DirectorDirector Jan 1, 2023 50%
W-2 Managing EmployeeDirector of Nursing Jan 1, 2023 50%
Operational/Managerial ControlDirector of Nursing Jan 1, 2023 100%
Sana Irfan Individual 5% Or Greater Direct Ownership InterestMember Jan 1, 2023 50%
Corporate OfficerMember Jan 1, 2023 50%
Corporate DirectorMember Jan 1, 2023 50%

NPI Registry JSON

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

{
    "created_epoch": "1688688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688688000000",
    "number": "1609554823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4550 W 103RD ST STE 301D",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604534868",
            "telephone_number": "708-996-5898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4550 W 103RD ST STE 301D",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604534868",
            "telephone_number": "708-996-5898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUALITY OF LIFE HOSPICE & PALLIATIVE CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-07",
        "last_updated": "2023-07-07",
        "certification_date": "2023-07-07",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "RONYA",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "708-996-5898"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Lawn, IL

Sources for this page

Verify at the official NPI Registry.