Provider Demographics
NPI:1134871437
Name:ETECON HOSPICE ILLINOIS INC
Entity type:Organization
Organization Name:ETECON HOSPICE ILLINOIS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:NOCETE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:888-984-8220
Mailing Address - Street 1:332 S MICHIGAN AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-4434
Mailing Address - Country:US
Mailing Address - Phone:888-984-8220
Mailing Address - Fax:888-984-4244
Practice Address - Street 1:332 S MICHIGAN AVE STE 102
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-4434
Practice Address - Country:US
Practice Address - Phone:888-984-8220
Practice Address - Fax:888-984-4244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based