Provider Demographics
NPI:1336382514
Name:EDWARD J. HINES HOSPITAL
Entity Type:Organization
Organization Name:EDWARD J. HINES HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LOLITA
Authorized Official - Middle Name:
Authorized Official - Last Name:DRUMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LSW, CADC
Authorized Official - Phone:708-202-4434
Mailing Address - Street 1:5650 N SHERIDAN RD
Mailing Address - Street 2:APT 22C
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-4879
Mailing Address - Country:US
Mailing Address - Phone:773-878-8729
Mailing Address - Fax:708-202-4954
Practice Address - Street 1:5000 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141-3030
Practice Address - Country:US
Practice Address - Phone:708-202-4434
Practice Address - Fax:708-202-4954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-17
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150004789273R00000X
IL24038276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit