Provider Demographics
NPI:1871538603
Name:ADVENTIST HEALTH PARTNERS,INC
Entity type:Organization
Organization Name:ADVENTIST HEALTH PARTNERS,INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-856-6884
Mailing Address - Street 1:412 63RD ST
Mailing Address - Street 2:STE 103
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-2000
Mailing Address - Country:US
Mailing Address - Phone:630-719-5472
Mailing Address - Fax:630-719-5466
Practice Address - Street 1:412 63RD ST
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-2000
Practice Address - Country:US
Practice Address - Phone:630-719-5472
Practice Address - Fax:630-719-5466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL400480Medicare ID - Type Unspecified