Provider Demographics
NPI:1922245968
Name:GIFT OF HOPE ORGAN & TISSUE DONOR NETWORK
Entity Type:Organization
Organization Name:GIFT OF HOPE ORGAN & TISSUE DONOR NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKINS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:630-758-2600
Mailing Address - Street 1:425 SPRING LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ITASCA
Mailing Address - State:IL
Mailing Address - Zip Code:60143-2076
Mailing Address - Country:US
Mailing Address - Phone:630-758-2600
Mailing Address - Fax:630-758-2601
Practice Address - Street 1:425 SPRING LAKE DR
Practice Address - Street 2:
Practice Address - City:ITASCA
Practice Address - State:IL
Practice Address - Zip Code:60143-2076
Practice Address - Country:US
Practice Address - Phone:630-758-2600
Practice Address - Fax:630-758-2601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-13
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
14HL07Medicare Oscar/Certification