Provider Demographics
NPI:1730615063
Name:BROOKDALE HOSPICE, LLC
Entity type:Organization
Organization Name:BROOKDALE HOSPICE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER, REGULATORY PRACTICES
Authorized Official - Prefix:
Authorized Official - First Name:DONNIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-564-8181
Mailing Address - Street 1:111 WESTWOOD PL
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5021
Mailing Address - Country:US
Mailing Address - Phone:615-564-8181
Mailing Address - Fax:414-292-4868
Practice Address - Street 1:3701 ALGONQUIN RD STE 100
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-3115
Practice Address - Country:US
Practice Address - Phone:847-635-6199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-05
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
141665Medicare UPIN