Active NPI
Quality of Life Hospice & Palliative Care LLC
- Community Based Hospice Care Agency
- Oak Lawn, IL
National Provider Identifier
1609554823
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Based Hospice Care Agency
- 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
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) | Code | License | State | Primary |
|---|---|---|---|---|
| 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 ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
- LLC
- 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 LLC
- Certified
- Aug 5, 2024
- Medicare certification status
- Active
National Provider Directory
National Provider DirectoryOwnership & 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.
| Name | Role | Since | Share |
|---|---|---|---|
| Ronya Johnson | 5% Or Greater Direct Ownership Interest | Jan 1, 2023 | 50% |
| Corporate Officer | Jan 1, 2023 | 50% | |
| Corporate Director | Jan 1, 2023 | 50% | |
| W-2 Managing Employee | Jan 1, 2023 | 50% | |
| Operational/Managerial Control | Jan 1, 2023 | 100% | |
| Sana Irfan | 5% Or Greater Direct Ownership Interest | Jan 1, 2023 | 50% |
| Corporate Officer | Jan 1, 2023 | 50% | |
| Corporate Director | 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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2023; 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.