Basic Information
| Provider Information | |||||||||
| NPI: | 1619002284 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVOCATE LUTHERAN GENERAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6141 N HOYNE AVE | ||||||||
| Address2: | UNIT 2 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606594279 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475672184 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1775 DEMPSTER ST | ||||||||
| Address2: | |||||||||
| City: | PARK RIDGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600681143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477237313 | ||||||||
| FaxNumber: | 8477232394 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2007 | ||||||||
| LastUpdateDate: | 06/16/2008 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | SHANNON | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | LCSW | ||||||||
| AuthorizedOfficialTelephone: | 8475672184 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 149010478 | IL | Y | Hospitals | General Acute Care Hospital |
No ID Information.