MEDICARE: RESURRECTION HEALTH CARE PREFERRED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1538264148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESURRECTION HEALTH CARE PREFERRED

Provider Business Mailing Address
First Line	:	355 RIDGE AVE
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60202-3328
Country	:	US
Telephone Number	:	847-316-4719
Fax Number	:	847-316-6346

Provider Business Practice Location Address
First Line	:	7345 W TALCOTT AVE
Second Line	:	FINANCE DEPARTMENT
City	:	CHICAGO
State	:	IL
Zip	:	60631-3706
Country	:	US
Telephone Number	:	773-792-5115
Fax Number	:	773-549-8567

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. LENORE RUTH KANARY
Credential	:
Telephone Number	:	847-316-4719

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	07/02/2008

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