Provider Demographics
NPI:1063833929
Name:ALEXIAN BROTHERS MEDICAL CENTER
Entity Type:Organization
Organization Name:ALEXIAN BROTHERS MEDICAL CENTER
Other - Org Name:ALEXIAN BROTHERS MEDICAL CENTER OLDER ADULT BEHAVIORAL HEALTH UNIT
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT, BUDGET/DECISION
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-590-2555
Mailing Address - Street 1:800 BIESTERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3361
Mailing Address - Country:US
Mailing Address - Phone:847-437-5500
Mailing Address - Fax:
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3361
Practice Address - Country:US
Practice Address - Phone:847-437-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALEXIAN BROTHERS MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-19
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2132855273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14S258Medicare Oscar/Certification