Basic Information
| Provider Information | |||||||||
| NPI: | 1336184563 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HSHS HOLY FAMILY HOSPITAL INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HSHS HOLY FAMILY HEALTH CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 HEALTHCARE DR | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622461159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186642531 | ||||||||
| FaxNumber: | 6186642553 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 HEALTHCARE DR | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622461159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186642531 | ||||||||
| FaxNumber: | 6186642553 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2006 | ||||||||
| LastUpdateDate: | 07/27/2016 | ||||||||
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| AuthorizedOfficialLastName: | NALL | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6186641230 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | IL | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.