Provider Demographics
NPI:1831463975
Name:CENTRAL DUPAGE HOSPITAL
Entity Type:Organization
Organization Name:CENTRAL DUPAGE HOSPITAL
Other - Org Name:CADENCE HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICAL THERAPIST ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CICERO
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:630-315-1712
Mailing Address - Street 1:25 N WINFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190
Mailing Address - Country:US
Mailing Address - Phone:630-315-1712
Mailing Address - Fax:
Practice Address - Street 1:25 N WINFIELD ROAD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190
Practice Address - Country:US
Practice Address - Phone:630-315-1712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160-003904282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital