Provider Demographics
NPI:1902852460
Name:RESURRECTION SERVICES
Entity Type:Organization
Organization Name:RESURRECTION SERVICES
Other - Org Name:RESURRECTION IMMEDIATE CARE CENTER ELMWOOD PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SYSTEM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-797-3603
Mailing Address - Street 1:15330 S LA GRANGE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-3885
Mailing Address - Country:US
Mailing Address - Phone:708-675-8160
Mailing Address - Fax:708-364-7474
Practice Address - Street 1:7230 W NORTH AVE
Practice Address - Street 2:STE 106B RESURRECTION IMMEDIATE CARE CENTER ELMWOOD PAR
Practice Address - City:ELMWOOD PARK
Practice Address - State:IL
Practice Address - Zip Code:60707-4262
Practice Address - Country:US
Practice Address - Phone:708-453-3000
Practice Address - Fax:708-453-4460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILGRP 1619414OtherBCBS
IL=========6030501Medicaid
ILGRP 1619414OtherBCBS