Provider Demographics
NPI:1457397317
Name:ADVENTIST MIDWEST HEALTH
Entity Type:Organization
Organization Name:ADVENTIST MIDWEST HEALTH
Other - Org Name:UCHICAGO MEDICINE ADVENTHEALTH HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CULLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-856-6062
Mailing Address - Street 1:5101 WILLOW SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2600
Mailing Address - Country:US
Mailing Address - Phone:708-245-6901
Mailing Address - Fax:708-245-6919
Practice Address - Street 1:5101 WILLOW SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-2600
Practice Address - Country:US
Practice Address - Phone:708-245-6901
Practice Address - Fax:708-245-6919
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVENTIST MIDWEST HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-21
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1693721251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147207OtherGREAT WEST HEALTHCARE
IL363106866001Medicaid
IL147207OtherUNICARE
IL6000397OtherUNITED HEALTHCARE
IL147207OtherHUMANA GOLD CHC MCR
IL9627OtherBLUE CROSS BLUE SHIELD IL
IL147207OtherSETERLIN GLIFE MCR
IL147207OtherSETERLIN GLIFE MCR
IL147207OtherHUMANA GOLD CHC MCR
IL=========OtherALLSTATE INSURANCE
IL=========OtherHFN INC.
IL=========013OtherTRICARE
IL363106866001Medicaid