Provider Demographics
NPI:1558957324
Name:HADZIDE, REUBEN C (REGISTERED NURSE, RN)
Entity Type:Individual
Prefix:MR
First Name:REUBEN
Middle Name:C
Last Name:HADZIDE
Suffix:
Gender:M
Credentials:REGISTERED NURSE, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5291 PROVIDENCE DR.
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20200 GOVERNORS DR STE 204
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1056
Practice Address - Country:US
Practice Address - Phone:708-991-7126
Practice Address - Fax:312-229-0067
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.270574311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home