Provider Demographics
NPI:1518982396
Name:EDWARD HINES JUNIOR VETERANS HOSPITAL
Entity Type:Organization
Organization Name:EDWARD HINES JUNIOR VETERANS HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL NURSE SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:REGINA
Authorized Official - Last Name:FOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, APN
Authorized Official - Phone:708-202-8387
Mailing Address - Street 1:FIFTH AVENUE AT ROOSEVELT ROAD
Mailing Address - Street 2:ROUTE 116A3
Mailing Address - City:HINES
Mailing Address - State:IL
Mailing Address - Zip Code:60141
Mailing Address - Country:US
Mailing Address - Phone:708-202-8387
Mailing Address - Fax:708-202-2024
Practice Address - Street 1:FIFTH AVENUE AT ROOSEVELT ROAD
Practice Address - Street 2:ROUTE 116A3
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141
Practice Address - Country:US
Practice Address - Phone:708-202-8387
Practice Address - Fax:708-202-2024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Single Specialty