Provider Demographics
NPI:1568538387
Name:PRESENCE CENTRAL AND SUBURBAN HOSPITALS NETWORK
Entity Type:Organization
Organization Name:PRESENCE CENTRAL AND SUBURBAN HOSPITALS NETWORK
Other - Org Name:PRESENCE ST. JOSEPH HOSPITAL - ELGIN PSYCHIATRIC UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AMITA CFO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-273-2350
Mailing Address - Street 1:77 N AIRLITE ST
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4912
Mailing Address - Country:US
Mailing Address - Phone:847-622-2086
Mailing Address - Fax:847-669-7624
Practice Address - Street 1:77 N AIRLITE ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4912
Practice Address - Country:US
Practice Address - Phone:847-622-2086
Practice Address - Fax:847-669-7624
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESENCE HOSPITALS PRV
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-24
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0004887273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL00055OtherBCBS IL INPATIENT PSYCH
IL00055OtherBCBS IL INPATIENT PSYCH