Basic Information
| Provider Information | |||||||||
| NPI: | 1477572949 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ADVENTIST GLENOAKS HOSPITAL | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | ADVENTHEALTH GLENOAKS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 701 WINTHROP AVE | ||||||||
| Address2: | |||||||||
| City: | GLENDALE HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601391405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305458000 | ||||||||
| FaxNumber: | 6303127975 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 WINTHROP AVE | ||||||||
| Address2: | |||||||||
| City: | GLENDALE HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601391405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305458000 | ||||||||
| FaxNumber: | 6303127975 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 04/18/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | JARED | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8475902496 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ADVENTIST GLENOAKS HOSPITAL | ||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | 0003814 | IL | Y | Hospital Units | Psychiatric Unit |
No ID Information.