Healthcare Provider Details

I. General information

NPI: 1235117888
Provider Name (Legal Business Name): GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3249 SOUTH OAK PARK AVE
BERWYN IL
60402
US

IV. Provider business mailing address

3249 OAK PARK AVE
BERWYN IL
60402-3429
US

V. Phone/Fax

Practice location:
  • Phone: 708-783-3222
  • Fax: 708-783-3489
Mailing address:
  • Phone: 708-216-0378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0005082
License Number StateIL

VIII. Authorized Official

Name: ADENRELE KOLAWOLE
Title or Position: DIRECTOR BILLING AND COLLECTIONS
Credential:
Phone: 708-216-3743