NPIMap

Organization Active NPI

Angels Grace Hospice, LLC

  • Community Based Hospice Care Agency
  • Bolingbrook, IL
National Provider Identifier
1962782995
Registry record updated Aug 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
ANGELS GRACE HOSPICE, LLC
Practice address
440 Quadrangle Drive
Suite G
Bolingbrook, IL 60440
Phone
(888) 444-8341
Fax
(630) 633-6367
NPI assigned
Aug 22, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2021

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

Authorized official

Name
Gregory James Zrazik
Title
Cfo
Phone
(312) 259-4716

Specialties & licenses 1

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

Addresses

Primary practice location

440 Quadrangle Drive
Suite G
Bolingbrook, IL 60440

Mailing address

440 Quadrangle Drive
Suite G
Bolingbrook, IL 60440
Phone (888) 444-8341

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120322000329 IL Part A Provider - Hospice 4587824925 Practice locations: Bolingbrook, IL
O20201104001289 IL Part B Supplier - Clinic/Group Practice 4587824925 Receives reassigned benefits from 3 practitioners
Practice locations: Bolingbrook, IL

Hospice certification: CCN 141644

Legal name
ANGELS GRACE HOSPICE LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jul 27, 2012
Last certification
Jul 17, 2015
Ownership / control type
Proprietary - Other
Organization structure
LLCProprietary
Enrollment address
440 Quadrangle Dr
Ste G
Bolingbrook, IL 60440-3455

Care Compare: Hospice

Medicare Care Compare
Listed as
Angels Grace HospiceCCN 141644
Ownership
For-Profit
Certified
Jul 27, 2012
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

440 Quadrangle Dr
Ste G
Bolingbrook, IL 60440
Phone (630) 633-7553

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Traci Miliauskas-Varak Individual W-2 Managing EmployeeAdministrator Jan 24, 2020 50%
Richard N Clark Individual Contracted Managing EmployeeAssociate Medical Director Apr 1, 2024 10%
Marilyn Colley Individual W-2 Managing EmployeeAssistant Administrator Jan 10, 2020 5%
Sharmaine Singleton Individual W-2 Managing EmployeeAssistant Clinical Director Jan 10, 2020 5%
Aracely Rios Individual W-2 Managing EmployeeClinical Director Jan 10, 2020 10%
Lawrence R Lapalio Individual Contracted Managing EmployeeMD; Jun 14, 2017 10%
Dierdre Shultz Czajkowski Individual W-2 Managing EmployeeDirector Or Marketing Apr 1, 2024
Edward J Kearney Individual Corporate OfficerPresident Sep 1, 2016 100%
Corporate DirectorDirector Aug 1, 2011 25%
Jay a Nollman Jr Family/Illinos Q-Tip Tust U/T/D Organization, Chicago, IL 5% Or Greater Direct Ownership Interest Sep 1, 2016 28.5%
Heather Coocke Individual W-2 Managing EmployeeAdmissions Director Feb 16, 2019 5%
Jane a. Nollman Trust U/T/D 8/22/01 Organization, Chicago, IL 5% Or Greater Direct Ownership Interest Aug 31, 2018 21.5%
Gregory J Zrazik Individual 5% Or Greater Direct Ownership Interest May 20, 2025 25%
Corporate OfficerSecretary, Vice President Aug 1, 2011 25%
Corporate DirectorDirector Aug 28, 2015 25%
W-2 Managing EmployeeChief Financial Officer/Chairman Aug 1, 2011 25%
Jane Nollman Individual Corporate DirectorDirector Aug 28, 2015 50%

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 24

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1313971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629417600000",
    "number": "1962782995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 QUADRANGLE DRIVE",
            "address_2": "SUITE G",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "60440",
            "telephone_number": "888-444-8341",
            "fax_number": "630-633-6367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 QUADRANGLE DRIVE",
            "address_2": "SUITE G",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "60440",
            "telephone_number": "888-444-8341",
            "fax_number": "630-633-6367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANGELS GRACE HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-22",
        "last_updated": "2021-08-20",
        "certification_date": "2021-08-20",
        "status": "A",
        "authorized_official_last_name": "ZRAZIK",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "312-259-4716"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bolingbrook, IL

Sources for this page

Verify at the official NPI Registry.