Provider Demographics
NPI:1558791657
Name:ADVENTIST HEALTH PARTNERS, INC
Entity Type:Organization
Organization Name:ADVENTIST HEALTH PARTNERS, INC
Other - Org Name:RIVERSIDE FAMILY PRACTICE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-856-6884
Mailing Address - Street 1:105 E BURLINGTON ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-2146
Mailing Address - Country:US
Mailing Address - Phone:708-442-0333
Mailing Address - Fax:708-442-9863
Practice Address - Street 1:105 E BURLINGTON ST
Practice Address - Street 2:SUITE C
Practice Address - City:RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-2146
Practice Address - Country:US
Practice Address - Phone:708-442-0333
Practice Address - Fax:708-442-9863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-26
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty