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1649515735

NPI Code Detail

MEDICARE: PRESENCE HOLY FAMILY MEDICAL CENTER

MEDICARE: PRESENCE HOLY FAMILY MEDICAL CENTER

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	282E00000X	Long Term Care Hospital	056007151	IL
2	282E00000X	Long Term Care Hospital

General Provider Information

NPI Number	:	1649515735
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESENCE HOLY FAMILY MEDICAL CENTER

Provider Business Mailing Address
First Line	:	1000 REMINGTON BLVD
Second Line	:	SUITE 100
City	:	BOLLINGBROOK
State	:	IL
Zip	:	60440-0000
Country	:	US
Telephone Number	:	630-914-2417
Fax Number	:	630-914-2499

Provider Business Practice Location Address
First Line	:	100 N. RIVER ROAD
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60016-0000
Country	:	US
Telephone Number	:	847-297-1800
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MGR
Name	:	MRS. MELVONNE WICKLIFFE-JONES
Credential	:
Telephone Number	:	630-914-2417

Provider Enumeration Date	:	11/30/2012
Last Update Date	:	05/08/2013

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Directions to “PRESENCE HOLY FAMILY MEDICAL CENTER ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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