Provider Demographics
NPI:1386815231
Name:NORTHWEST COMMUNITY HEALTHCARE
Entity Type:Organization
Organization Name:NORTHWEST COMMUNITY HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:ZENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-618-5017
Mailing Address - Street 1:3060 W SALT CREEK LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-5026
Mailing Address - Country:US
Mailing Address - Phone:847-618-1000
Mailing Address - Fax:847-618-5009
Practice Address - Street 1:3060 W SALT CREEK LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-5026
Practice Address - Country:US
Practice Address - Phone:847-618-1000
Practice Address - Fax:847-618-5009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL186526OtherDORAL DENTAL