1760826358 NPI number — ADONIA HEALTH SYSTEM, CORP

Table of content: LISA NICOLE SMITH PT (NPI 1790762680)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760826358 NPI number — ADONIA HEALTH SYSTEM, CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADONIA HEALTH SYSTEM, CORP
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:
6
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:
1760826358
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 DEARBORN SQUARE, SUITE 530
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANKAKEE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60901-2814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-304-5044
Provider Business Mailing Address Fax Number:
815-614-3715

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 DEARBORN SQ STE 530
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANKAKEE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60901-3956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-304-5044
Provider Business Practice Location Address Fax Number:
815-614-3715
Provider Enumeration Date:
04/25/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ADEMIJU
Authorized Official First Name:
ESTHER
Authorized Official Middle Name:
OMOLOLA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
312-770-0271

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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