Provider Demographics
NPI:1477598589
Name:ALEXIAN BROTHERS MEDICAL CENTER
Entity Type:Organization
Organization Name:ALEXIAN BROTHERS MEDICAL CENTER
Other - Org Name:OLDER ADULT HEALTHCARE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR, OLDER ADULT INSTITUTE
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:B
Authorized Official - Last Name:GLUMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-364-6724
Mailing Address - Street 1:800 BIESTERFIELD RD
Mailing Address - Street 2:SUITE 605
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3311
Mailing Address - Country:US
Mailing Address - Phone:847-364-6724
Mailing Address - Fax:847-364-6720
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:SUITE 605
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3311
Practice Address - Country:US
Practice Address - Phone:847-364-6724
Practice Address - Fax:847-364-6720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209479Medicare ID - Type Unspecified
IL209433Medicare ID - Type Unspecified
IL837800Medicare ID - Type Unspecified