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Hospice & Home Health Record Maps

agency

PROVIDENCE HOSPICE

Homer Glen, IL

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CMS quality evidence by agency type

Hospice Care Index (0-10)
10 Source
Visits in last days of life
77 Source
Last-days measure denominator
257 Source
Process composite
96 Source
Process measure denominator
167 Source
Hospice average daily census
36 Source
Care Index period
01/01/2023-12/31/2024 Source

CMS enrollment and reported ownership

Enrolled legal organization
REST HAVEN ILLIANA CHRISTIAN CONVALESCENT HOME Source
Enrolled DBA name
PROVIDENCE HOSPICE Source
Enrolled NPI
1407855562 Source
Organization structure
CORPORATION Source
Incorporation date and state
1956-04-06 (IL) Source
Enrollment proprietary status
Non-profit Source
CMS enrollment records
1 Source
Distinct reported owners
20 Source
Reported owner relationships
20 Source
Owner roles, dates, shares, and classifications
AMY MOSORIAK [Individual; CMS owner ID 8820252828]; role: W-2 MANAGING EMPLOYEE; associated: 2022-04-01; ownership: 0%; PE: not reported; REIT: not reported, ARNOLD KOLDENHOVEN [Individual; CMS owner ID 6709048440]; role: CORPORATE DIRECTOR; associated: 2024-04-01; ownership: not reported; PE: not reported; REIT: not reported, BARRY VANDERGENUGTEN [Individual; CMS owner ID 3971762667]; role: W-2 MANAGING EMPLOYEE; associated: 2001-05-31; ownership: 0%; PE: not reported; REIT: not reported, DARREN VAN ESSEN [Individual; CMS owner ID 1153709555]; role: CORPORATE DIRECTOR; associated: 2022-04-01; ownership: 0%; PE: not reported; REIT: not reported, DAVE DEGRAFF [Individual; CMS owner ID 8426589847]; role: CORPORATE DIRECTOR; associated: 2024-04-01; ownership: not reported; PE: not reported; REIT: not reported, DAVID VOSS [Individual; CMS owner ID 3971981374]; role: CORPORATE DIRECTOR; associated: 2022-04-01; ownership: 0%; PE: not reported; REIT: not reported, EDWARD DAMSTRA [Individual; CMS owner ID 3072991470]; role: CORPORATE DIRECTOR; associated: 2022-04-01; ownership: 0%; PE: not reported; REIT: not reported, ERIC M WOO [Individual; CMS owner ID 4789778630]; role: CORPORATE DIRECTOR; associated: 2024-04-01; ownership: not reported; PE: not reported; REIT: not reported, GARY W LEO [Individual; CMS owner ID 6608307020]; role: CORPORATE DIRECTOR; associated: 2024-04-01; ownership: not reported; PE: not reported; REIT: not reported, JOHANNA ZANDSTRA [Individual; CMS owner ID 1153580840]; role: W-2 MANAGING EMPLOYEE; associated: 2000-04-24; ownership: 0%; PE: not reported; REIT: not reported, KAREN HUIZENGA [Individual; CMS owner ID 4981082385]; role: CORPORATE DIRECTOR; associated: 2022-04-01; ownership: 0%; PE: not reported; REIT: not reported, KENNETH ALAN HOVING [Individual; CMS owner ID 941110365]; role: CORPORATE DIRECTOR; associated: 2022-04-01; ownership: 0%; PE: not reported; REIT: not reported, KYLE YONKER [Individual; CMS owner ID 6305224999]; role: CORPORATE DIRECTOR; associated: 2024-04-01; ownership: not reported; PE: not reported; REIT: not reported, PATRICIA L JABAAY [Individual; CMS owner ID 8426436825]; role: CORPORATE DIRECTOR; associated: 2022-04-01; ownership: 0%; PE: not reported; REIT: not reported, PAUL BUIKEMA [Individual; CMS owner ID 2163800566]; role: CORPORATE DIRECTOR; associated: 2022-04-01; ownership: 0%; PE: not reported; REIT: not reported, REST HAVEN ILLIANA CHRISTIAN CONVALESCENT HOME [Organization; CMS owner ID 1052221470]; role: 5% OR GREATER DIRECT OWNERSHIP INTEREST; associated: 2003-02-10; ownership: 100%; PE: no; REIT: no, ROB PETROELJE [Individual; CMS owner ID 8325579741]; role: CORPORATE DIRECTOR; associated: 2024-04-01; ownership: not reported; PE: not reported; REIT: not reported, SANDHYA NAGUBADI [Individual; CMS owner ID 1850354226]; role: CONTRACTED MANAGING EMPLOYEE; associated: 2019-02-01; ownership: not reported; PE: not reported; REIT: not reported, THEODORE EARLE FEENSTRA [Individual; CMS owner ID 2860870458]; role: CORPORATE DIRECTOR; associated: 2024-04-01; ownership: not reported; PE: not reported; REIT: not reported, TIM BREEMS [Individual; CMS owner ID 5294962189]; role: CORPORATE DIRECTOR; associated: 2024-04-01; ownership: 0%; PE: not reported; REIT: not reported Source
Owners CMS marks as private equity
0 Source
Owners CMS marks as REITs
0 Source

Illinois state licensure

Illinois license type
Illinois Hospice Program Source
Illinois license number
2002251 Source
Published license expiration
2026-10-31 Source
IDPH directory status
Listed in IDPH current-license directory as of 2026-04-28 Source
CMS match
Exact name and ZIP, office address and ZIP, phone Source
Service area
Not published; IDPH parent-office county is not service area Source

CMS identity

Agency type
Hospice Source
Ownership type
Non-Profit Source
Phone
(800) 509-2800 Source
CMS address
14301 INDEPENDENCE WAY Source
ZIP code
60491 Source

Pricing

Published prices

Average submitted charges per hospice service day

$280.41

per hospice service day / provider-submitted charges divided by source utilization for Original Medicare fee-for-service claims

Current source Checked 2026-08-11 / Fiscal year 2024

Includes: CMS final-action Medicare fee-for-service Part A claims included in the PAC public-use file.

Excludes: A patient quote, beneficiary out-of-pocket amount, Medicaid or self-pay services, and current availability.

Calculated from CMS provider totals: 13,328 hospice service days, 187 distinct beneficiaries, $3,737,304 submitted charges, and $2,554,972 Medicare payment. Claims context only; not a provider price or patient cost.

CMS Medicare Post-Acute Care Utilization - Hospice by Geography and Provider source

Average Medicare payment per hospice service day

$191.70

per hospice service day / Medicare payment divided by source utilization for Original Medicare fee-for-service claims

Current source Checked 2026-08-11 / Fiscal year 2024

Includes: CMS final-action Medicare fee-for-service Part A claims included in the PAC public-use file.

Excludes: A patient quote, beneficiary out-of-pocket amount, Medicaid or self-pay services, and current availability.

Calculated from CMS provider totals: 13,328 hospice service days, 187 distinct beneficiaries, $3,737,304 submitted charges, and $2,554,972 Medicare payment. Claims context only; not a provider price or patient cost.

CMS Medicare Post-Acute Care Utilization - Hospice by Geography and Provider source

Market benchmarks

Average Medicare payment per hospice service day

$192.40

per hospice service day / Medicare payment divided by source utilization from CMS geographic totals

IL state benchmark / Hospice / Original Medicare fee-for-service beneficiaries in the CMS PAC public-use file

Current source Effective Fiscal year 2024 / Checked 2026-08-11

Weighted calculation from 3,958,243 hospice service days and 59,119 distinct beneficiaries. Claims context only; not a provider price, patient cost, or quote.

CMS Medicare Post-Acute Care Utilization - Hospice by Geography and Provider source

Average submitted charges per hospice service day

$310.55

per hospice service day / provider-submitted charges divided by source utilization from CMS geographic totals

IL state benchmark / Hospice / Original Medicare fee-for-service beneficiaries in the CMS PAC public-use file

Current source Effective Fiscal year 2024 / Checked 2026-08-11

Weighted calculation from 3,958,243 hospice service days and 59,119 distinct beneficiaries. Claims context only; not a provider price, patient cost, or quote.

CMS Medicare Post-Acute Care Utilization - Hospice by Geography and Provider source

Benchmarks describe the named market, not this provider's quoted price.

Source trail

Research workflow

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