1558690628 NPI number — LOYOLA UNIVERSITY SCHOOL OF NURSING - SCHOOL-BASED HEALTH CENTER

Table of content: (NPI 1558690628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558690628 NPI number — LOYOLA UNIVERSITY SCHOOL OF NURSING - SCHOOL-BASED HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOYOLA UNIVERSITY SCHOOL OF NURSING - SCHOOL-BASED HEALTH CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558690628
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2160 SOUTH FIRST AVENUE
Provider Second Line Business Mailing Address:
MAGUIRE - 105-2840
Provider Business Mailing Address City Name:
MAYWOOD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60153
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-449-9522
Provider Business Mailing Address Fax Number:
708-449-9525

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
807 SOUTH FIRST AVENUE
Provider Second Line Business Practice Location Address:
SCHOOL-BASED HEALTH CENTER AT PROVISO EAST HIGH SCHOOL
Provider Business Practice Location Address City Name:
MAYWOOD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-449-9522
Provider Business Practice Location Address Fax Number:
708-449-9525
Provider Enumeration Date:
12/18/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HACKBARTH
Authorized Official First Name:
DIANA
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
PROJECT DIRECTOR: LOYOLA UNIVERSITY
Authorized Official Telephone Number:
708-216-3670

Provider Taxonomy Codes

  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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