Basic Information
| Provider Information | |||||||||
| NPI: | 1003872649 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEARTLITE HOSPICE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 W. ROSSEVELT ROAD | ||||||||
| Address2: | SUITE C-206 | ||||||||
| City: | GLEN ELLYN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601375851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309420100 | ||||||||
| FaxNumber: | 2562591790 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 WEST CHARLOTTE AVENUE | ||||||||
| Address2: | |||||||||
| City: | SCOTTSBORO | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562591754 | ||||||||
| FaxNumber: | 2562591790 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2006 | ||||||||
| LastUpdateDate: | 01/29/2013 | ||||||||
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| AuthorizedOfficialLastName: | DANEKAS | ||||||||
| AuthorizedOfficialFirstName: | CURTIS | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFF | ||||||||
| AuthorizedOfficialTelephone: | 6309420100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CPA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 11278 | AL | Y | Agencies | Hospice Care, Community Based |
No ID Information.