Provider Demographics
NPI:1770504789
Name:NORTHWEST SUBURBAN COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:NORTHWEST SUBURBAN COMMUNITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:LENZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:734-547-1114
Mailing Address - Street 1:135 S PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-7914
Mailing Address - Country:US
Mailing Address - Phone:734-547-1114
Mailing Address - Fax:734-547-1145
Practice Address - Street 1:1625 S STATE ST
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-5907
Practice Address - Country:US
Practice Address - Phone:815-547-5441
Practice Address - Fax:815-544-0517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0004820282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
395OtherBCBS PROVIDER NUMBER
395OtherBCBS PROVIDER NUMBER
140205Medicare ID - Type Unspecified