Basic Information
Provider Information | |||||||||
NPI: | 1124141569 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | RESURRECTION SERVICES | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | WORKPLUS OCCUPATIONAL HEALTH | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 15330 S. LAGRANGE ROAD | ||||||||
Address2: | SUITE 203 | ||||||||
City: | ORLAND PARK | ||||||||
State: | IL | ||||||||
PostalCode: | 604623885 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7086758160 | ||||||||
FaxNumber: | 7083647474 | ||||||||
Practice Location | |||||||||
Address1: | WORKPLUS OCCUPATIONAL HEALTH DES PLAINES | ||||||||
Address2: | 100 N. RIVER ROAD | ||||||||
City: | DES PLAINES | ||||||||
State: | IL | ||||||||
PostalCode: | 600161209 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8472971800 | ||||||||
FaxNumber: | 8472975712 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/09/2007 | ||||||||
LastUpdateDate: | 12/08/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | HOBSON | ||||||||
AuthorizedOfficialFirstName: | DEAN | ||||||||
AuthorizedOfficialMiddleName: | M. | ||||||||
AuthorizedOfficialTitleorPosition: | SYSTEM DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 7737973603 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QX0100X |   | IL | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine |
ID Information
ID | Type | State | Issuer | Description | PENDING | 01 | IL | PENDING CREDENTIALING | OTHER |