Provider Demographics
NPI:1477572949
Name:ADVENTIST GLENOAKS HOSPITAL
Entity Type:Organization
Organization Name:ADVENTIST GLENOAKS HOSPITAL
Other - Org Name:ADVENTHEALTH GLENOAKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-943-4455
Mailing Address - Street 1:701 WINTHROP AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-1405
Mailing Address - Country:US
Mailing Address - Phone:630-545-8000
Mailing Address - Fax:630-312-7975
Practice Address - Street 1:701 WINTHROP AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139-1405
Practice Address - Country:US
Practice Address - Phone:630-545-8000
Practice Address - Fax:630-312-7975
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVENTIST GLENOAKS HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-18
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0003814273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14S292Medicare ID - Type Unspecified
IL14S292Medicare Oscar/Certification