Provider Demographics
NPI:1841361748
Name:LOYOLA UNIVERSITY CHILDREN'S HOSPITAL
Entity type:Organization
Organization Name:LOYOLA UNIVERSITY CHILDREN'S HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LUKASICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-216-5723
Mailing Address - Street 1:2160 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-3328
Mailing Address - Country:US
Mailing Address - Phone:708-216-0469
Mailing Address - Fax:708-216-0593
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-3328
Practice Address - Country:US
Practice Address - Phone:708-216-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL351282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1671580OtherBC FEDERAL HOME HEALTH
IL9729OtherBLUE CROSS HOME INFUSION
IL0500OtherBLUE CROSS
IL=========003Medicaid
IL=========005Medicaid
IL=========002Medicaid
IL=========004Medicaid
IL=========011Medicaid
IL=========401Medicaid
IL=========001Medicaid
IL14T276Medicare ID - Type UnspecifiedREHAB
IL=========401Medicaid
IL9729OtherBLUE CROSS HOME INFUSION
IL=========005Medicaid
IL1671580OtherBC FEDERAL HOME HEALTH
IL147257Medicare ID - Type UnspecifiedHOME HEALTH