Provider Demographics
NPI:1275740961
Name:ALEXIAN BROTHERS HOME INFUSION
Entity Type:Organization
Organization Name:ALEXIAN BROTHERS HOME INFUSION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AVP, ANCILLARY SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUNDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-233-5010
Mailing Address - Street 1:1515 E LAKE ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-4896
Mailing Address - Country:US
Mailing Address - Phone:630-233-5010
Mailing Address - Fax:630-233-5021
Practice Address - Street 1:1515 E LAKE ST
Practice Address - Street 2:SUITE 210
Practice Address - City:HANOVER PARK
Practice Address - State:IL
Practice Address - Zip Code:60133-4896
Practice Address - Country:US
Practice Address - Phone:630-233-5010
Practice Address - Fax:630-233-5021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1006824251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2232303OtherBCBS INFUSION NUMBER