Provider Demographics
NPI:1235870478
Name:LILY HOSPICE LLC
Entity type:Organization
Organization Name:LILY HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:RASIMUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-235-3115
Mailing Address - Street 1:15430 W CAPITOL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-2626
Mailing Address - Country:US
Mailing Address - Phone:262-235-3115
Mailing Address - Fax:262-537-5140
Practice Address - Street 1:15430 W CAPITOL DR STE 100
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-2626
Practice Address - Country:US
Practice Address - Phone:262-235-3115
Practice Address - Fax:262-537-5140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-03
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based