Provider Demographics
NPI:1972041440
Name:BLACK NURSES ROCK
Entity Type:Organization
Organization Name:BLACK NURSES ROCK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:I
Authorized Official - Credentials:RN
Authorized Official - Phone:312-391-2929
Mailing Address - Street 1:46 E 26TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2304
Mailing Address - Country:US
Mailing Address - Phone:312-391-2929
Mailing Address - Fax:
Practice Address - Street 1:46 E 26TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2304
Practice Address - Country:US
Practice Address - Phone:312-391-2929
Practice Address - Fax:312-326-3131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-05
Last Update Date:2017-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041153647251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable