Provider Demographics
NPI:1568638948
Name:EDWARD HINES JR. HOSPITAL
Entity Type:Organization
Organization Name:EDWARD HINES JR. HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:THRESIAMMA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PARACKAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-202-2020
Mailing Address - Street 1:1085 IDAHO ST
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-1348
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1085 IDAHO ST
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-1348
Practice Address - Country:US
Practice Address - Phone:630-871-9531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0412810692865M2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2865M2000XHospitalsMilitary HospitalMilitary General Acute Care Hospital