Provider Demographics
NPI:1922145994
Name:WESTLAKE COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:WESTLAKE COMMUNITY HOSPITAL
Other - Org Name:WESTLAKE HOSPITAL REHAB UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SYSTEM DIRECTOR, PFS
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PFISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-792-9903
Mailing Address - Street 1:1225 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-4039
Mailing Address - Country:US
Mailing Address - Phone:708-938-7020
Mailing Address - Fax:
Practice Address - Street 1:1225 W LAKE ST
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-4039
Practice Address - Country:US
Practice Address - Phone:708-938-7020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0074OtherILLINOIS BX
IL0074OtherILLINOIS BX
IL14T240Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER