HOSPICE OF KANKAKEE VALLEY PALLIATIVE CLINIC
NPI 1104906767
Hospice, Inpatient in Bourbonnais, IL
NPI Status: Active since October 17, 2006
Contact Information
482 MAIN STREET NW
BOURBONNAIS, IL
ZIP 60914
Phone: (815) 936-3370
Fax: (815) 936-3375
- Organization
- Hospice, Inpatient
- CLIA Number: 14D0429285
- CLIA Cert. Type: Hospice
- CLIA Exp. Date: 07-21-2027
About HOSPICE OF KANKAKEE VALLEY PALLIATIVE CLINIC
This page provides the complete NPI Profile along with additional information for Hospice Of Kankakee Valley Palliative Clinic, a provider established in Bourbonnais, Illinois operating as a Hospice, Inpatient. The healthcare provider is registered in the NPI registry with number 1104906767 assigned on October 2006. The practitioner's primary taxonomy code is 315D00000X with license number 2000420 (IL). The provider is registered as an organization and their NPI record was last updated 6 years ago. The authorized official of this NPI record is Ms. Dorothea M. Lagesse Mba, Hacp (Executive Director)
- NPI
- 1104906767
- Provider Name
- HOSPICE OF KANKAKEE VALLEY PALLIATIVE CLINIC
- Entity Type
- Organization
- Location Address
- 482 MAIN STREET NW BOURBONNAIS, IL 60914
- Location Phone
- (815) 936-3370
- Location Fax
- (815) 936-3375
- Mailing Address
- 482 MAIN STREET NW BOURBONNAIS, IL 60914
- Mailing Phone
- (815) 936-3370
- Mailing Fax
- (815) 936-3375
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 10-17-2006
- Last Update Date
- 08-22-2020
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Hospice, Inpatient
- Taxonomy Code
- 315D00000X
- Type
- Nursing & Custodial Care Facilities
- License No.
- 2000420
- License State
- IL
- Taxonomy Description
- A provider organization, or distinct part of the organization, which renders an interdisciplinary program providing palliative care, chiefly medical relief of pain and supporting services, which addresses the emotional, social, financial, and legal needs of terminally ill patients and their families where an institutional care environment is required for the patient.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 14D0429285
- Facility Type
- Hospice
- Certificate Effective Date
- July 22, 2025
- Certificate Expiration Date
- July 21, 2027
- Laboratory Director
- FAWN A. HENDERSHOTT
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Hospice Of Kankakee Valley Palliative Clinic to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1104906767, we treat the final digit (7) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 53. The final step is to find the difference between that total and the next multiple of ten (60 - 53 = 7).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 53 is 60. The difference is the calculated check digit.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1104906767, enumerated as an "organization" on October 17, 2006.
The provider is located at 482 MAIN STREET NW BOURBONNAIS, IL 60914 and the phone number is (815) 936-3370.
Hospice, Inpatient with taxonomy code 315D00000X.
