Provider Demographics
NPI:1659624849
Name:ADVENTIST HEALTH PARTNERS, INC
Entity Type:Organization
Organization Name:ADVENTIST HEALTH PARTNERS, INC
Other - Org Name:D.O.C. FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-856-6884
Mailing Address - Street 1:6723 ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-1007
Mailing Address - Country:US
Mailing Address - Phone:708-383-6346
Mailing Address - Fax:708-383-6346
Practice Address - Street 1:6723 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-1007
Practice Address - Country:US
Practice Address - Phone:708-383-6346
Practice Address - Fax:708-383-6346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-25
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty