Provider Demographics
NPI:1710456199
Name:BENEDICTINE UNIVERSITY
Entity Type:Organization
Organization Name:BENEDICTINE UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATHLETIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCHORNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-829-6150
Mailing Address - Street 1:5700 COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-0900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5700 COLLEGE RD
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-0900
Practice Address - Country:US
Practice Address - Phone:630-829-6154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty