Provider Demographics
NPI:1760730063
Name:SACRED HEART HOSPITAL
Entity Type:Organization
Organization Name:SACRED HEART HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MEDICAL AFFAIRS
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MULDROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-265-7307
Mailing Address - Street 1:3240 W FRANKLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60624-1511
Mailing Address - Country:US
Mailing Address - Phone:773-722-3320
Mailing Address - Fax:
Practice Address - Street 1:3240 W FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60624-1511
Practice Address - Country:US
Practice Address - Phone:773-722-3320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-17
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008315282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital