Provider Demographics
NPI:1760421697
Name:ALEXIAN BROTHERS MEDICAL CENTER
Entity Type:Organization
Organization Name:ALEXIAN BROTHERS MEDICAL CENTER
Other - Org Name:ALEXIAN BROTHERS HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, BUDGET/DECISION SUP
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-590-2555
Mailing Address - Street 1:1515 E LAKE ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-4896
Mailing Address - Country:US
Mailing Address - Phone:630-233-5000
Mailing Address - Fax:630-233-5021
Practice Address - Street 1:1515 E LAKE ST
Practice Address - Street 2:SUITE 210
Practice Address - City:HANOVER PARK
Practice Address - State:IL
Practice Address - Zip Code:60133-4896
Practice Address - Country:US
Practice Address - Phone:630-233-5000
Practice Address - Fax:630-233-5021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1006824251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2232303OtherBC/BS INFUSION NUMBER
IL9697OtherBC/BS HOME HEALTH LICENSE
IL1006824OtherHOME HEALTH LICENSE
IL=========002Medicaid
IL147583Medicare Oscar/Certification