Provider Demographics
NPI:1578689063
Name:ELMHURST PHYSICIAN HOSPITAL ORGANIZATION LLC
Entity Type:Organization
Organization Name:ELMHURST PHYSICIAN HOSPITAL ORGANIZATION LLC
Other - Org Name:ELMCARE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-833-8200
Mailing Address - Street 1:200 N BERTEAU AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2966
Mailing Address - Country:US
Mailing Address - Phone:630-833-8200
Mailing Address - Fax:630-993-5619
Practice Address - Street 1:855 N CHURCH RD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-1005
Practice Address - Country:US
Practice Address - Phone:630-833-8200
Practice Address - Fax:630-993-5619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL60019747302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization