Provider Demographics
NPI:1063454387
Name:ADVENTIST HEALTH PARTNERS,INC
Entity Type:Organization
Organization Name:ADVENTIST HEALTH PARTNERS,INC
Other - Org Name:BROOKFIELD WOMEN'S HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-856-6884
Mailing Address - Street 1:5201 S. WILLOW SPRINGS RD
Mailing Address - Street 2:STE 120
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525
Mailing Address - Country:US
Mailing Address - Phone:708-245-6097
Mailing Address - Fax:708-245-5783
Practice Address - Street 1:5201 S. WILLOW SPRINGS RD
Practice Address - Street 2:STE 120
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525
Practice Address - Country:US
Practice Address - Phone:708-245-6097
Practice Address - Fax:708-245-5783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL403270Medicare ID - Type Unspecified