Provider Demographics
NPI:1568099307
Name:GREATER HEIGHTS P MEDICAL SERVICES
Entity Type:Organization
Organization Name:GREATER HEIGHTS P MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ODEFADEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:224-659-2484
Mailing Address - Street 1:1005 S EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-3144
Mailing Address - Country:US
Mailing Address - Phone:847-749-0542
Mailing Address - Fax:630-451-9896
Practice Address - Street 1:1005 S EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-3144
Practice Address - Country:US
Practice Address - Phone:847-749-0542
Practice Address - Fax:630-451-9896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-23
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1063900603Medicaid