Provider Demographics
NPI:1720314115
Name:ALEXIAN BROTHERS MEDICAL CENTER
Entity Type:Organization
Organization Name:ALEXIAN BROTHERS MEDICAL CENTER
Other - Org Name:ALEXIAN BROTHERS HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-590-2555
Mailing Address - Street 1:1515 E LAKE ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-4869
Mailing Address - Country:US
Mailing Address - Phone:630-233-5100
Mailing Address - Fax:630-233-5101
Practice Address - Street 1:1515 E LAKE ST
Practice Address - Street 2:SUITE 206
Practice Address - City:HANOVER PARK
Practice Address - State:IL
Practice Address - Zip Code:60133-4869
Practice Address - Country:US
Practice Address - Phone:630-233-5100
Practice Address - Fax:630-233-5101
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALEXIAN BROTHERS MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-20
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2002731251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7340OtherJOINT COMMISSION NUMBER
IL2002731OtherSTATE LICENSE
IL7340OtherJOINT COMMISSION NUMBER