Basic Information
| Provider Information | |||||||||
| NPI: | 1568472819 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROSELAND COMMUNITY HOSPITAL ASSOCIATION | ||||||||
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| OtherOrganizationName: | ROSELAND COMMUNITY HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 45 W 111TH ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606284200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7739953000 | ||||||||
| FaxNumber: | 7739956602 | ||||||||
| Practice Location | |||||||||
| Address1: | 45 W 111TH ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606284200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7739953000 | ||||||||
| FaxNumber: | 7739956602 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 11/27/2019 | ||||||||
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| AuthorizedOfficialLastName: | EGAN | ||||||||
| AuthorizedOfficialFirstName: | TIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7739953000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084A0401X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Medicine | 273R00000X | 0002063 | IL | N | Hospital Units | Psychiatric Unit | 283Q00000X | 0002063 | IL | N | Hospitals | Psychiatric Hospital | 332B00000X | 0002063 | IL | N | Suppliers | Durable Medical Equipment & Medical Supplies | 282N00000X | 0002063 | IL | Y | Hospitals | General Acute Care Hospital |
No ID Information.