Basic Information
| Provider Information | |||||||||
| NPI: | 1730589946 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRESENCE ST JOSEPH HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2900 N LAKE SHORE DR | ||||||||
| Address2: | SUITE 203, MEDICAL EDUCATION BUILDING | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606575640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7736653022 | ||||||||
| FaxNumber: | 7736653228 | ||||||||
| Practice Location | |||||||||
| Address1: | 2900 N LAKE SHORE DR | ||||||||
| Address2: | SUITE 203, MEDICAL EDUCATION BUILDING | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606575640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7736653022 | ||||||||
| FaxNumber: | 7736653228 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2014 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | BOSKOVIK | ||||||||
| AuthorizedOfficialFirstName: | TRISH | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL EDUCATION COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 7736653022 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282E00000X | IL | Y | Hospitals | Long Term Care Hospital |
No ID Information.