1366521296 NPI number — PRESENCE CHICAGO HOSPITALS NETWORK

Table of content: (NPI 1366521296)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366521296 NPI number — PRESENCE CHICAGO HOSPITALS NETWORK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRESENCE CHICAGO HOSPITALS NETWORK
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:
SAINT JOSEPH HOSPITAL - CHICAGO PSYCHIATRIC UNIT
Provider Other Organization Name Type Code:
3
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:
1366521296
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2900 N LAKE SHORE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60657-5640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-665-3236
Provider Business Mailing Address Fax Number:
773-665-3435

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1127 N OAKLEY BLVD
Provider Second Line Business Practice Location Address:
4TH FLOOR
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60622-3507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-572-8500
Provider Business Practice Location Address Fax Number:
773-572-8568
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NEUMAN
Authorized Official First Name:
LISA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
VP FINANCE
Authorized Official Telephone Number:
224-273-0516

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 363200170001 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0415 . This is a "IL BX PROVIDER NUMB" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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