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

Table of Contents

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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