NPIMap

Organization Active NPI

Alexian Brothers Medical Center

Doing business as Alexian Brothers Hospice

  • Community Based Hospice Care Agency
  • Hanover Park, IL
National Provider Identifier
1720314115
Registry record updated Jan 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
2002731 Issued in IL
Legal business name
ALEXIAN BROTHERS MEDICAL CENTER
Doing business as
Alexian Brothers Hospice
Practice address
1515 E Lake St
Suite 206
Hanover Park, IL 60133-4869
Phone
(630) 233-5100
Fax
(630) 233-5101
NPI assigned
Oct 20, 2009
Last updated
Jan 27, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
ALEXIAN BROTHERS MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 27, 2025

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

Authorized official

Name
Lisa Neuman
Title
Vice President
Phone
(847) 437-5500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 2002731 IL Primary

Addresses

Primary practice location

1515 E Lake St
Suite 206
Hanover Park, IL 60133-4869

Mailing address

1515 E Lake St
Suite 206
Hanover Park, IL 60133-4869
Phone (630) 233-5100

Other identifiers 2

IdentifierTypeStateIssuer
7340OtherILJOINT COMMISSION NUMBER
2002731OtherILSTATE LICENSE

Other names 1

  • Alexian Brothers Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100518000235 IL Part A Provider - Hospice 7315859170 Practice locations: Elk Grove Village, IL; Hanover Park, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720314115. Details of each certification follow.

Hospice certification: CCN 141632

Legal name
ALEXIAN BROTHERS MEDICAL CENTER
Doing business as
ALEXIAN BROTHERS HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Oct 13, 2009
Last certification
Oct 13, 2009
Ownership / control type
Non-Profit - Church
Organization structure
CorporationNon-profit
Enrollment address
1515 E Lake St
Ste 206
Hanover Park, IL 60133-7152

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
Alexian Brothers HospiceCCN 141632 · All quality measures
Ownership
Non-Profit
Certified
Oct 13, 2009
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Alexian Brothers Med CT6 organizations share this tax ID, including this one
Part of
Alexian Brothers Med CT

Other organizations with this tax ID 5

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

Locations

1515 E Lake St
Ste 206
Hanover Park, IL 60133
Phone (630) 233-5100

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Eric Zornow Individual Corporate OfficerCfo Feb 17, 2025
W-2 Managing EmployeeCfo Feb 17, 2025
Mary Jo Mackniskas Individual Corporate Officer Mar 1, 2020
W-2 Managing Employee Mar 1, 2020
Alexian Brothers Health System Organization, Chicago, IL Corporation, Non-profit Operational/Managerial Control Oct 13, 2009
Ascension Health Organization, Saint Louis, MO Corporation, Non-profit Operational/Managerial Control Apr 1, 2022
Polly Davenport Individual Corporate Officer Apr 1, 2022

Facilities with the same owner 157

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

View all 157

Practitioners & affiliated clinicians

Affiliated clinicians 4

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": "1255996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737936000000",
    "number": "1720314115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 E LAKE ST",
            "address_2": "SUITE 206",
            "city": "HANOVER PARK",
            "state": "IL",
            "postal_code": "601334869",
            "telephone_number": "630-233-5100",
            "fax_number": "630-233-5101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 E LAKE ST",
            "address_2": "SUITE 206",
            "city": "HANOVER PARK",
            "state": "IL",
            "postal_code": "601334869",
            "telephone_number": "630-233-5100",
            "fax_number": "630-233-5101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALEXIAN BROTHERS MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ALEXIAN BROTHERS MEDICAL CENTER",
        "enumeration_date": "2009-10-20",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-27",
        "status": "A",
        "authorized_official_last_name": "NEUMAN",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "847-437-5500"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "IL",
            "license": "2002731",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOINT COMMISSION NUMBER",
            "identifier": "7340",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "2002731",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alexian Brothers Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hanover Park, IL

Sources for this page

Verify at the official NPI Registry.