Healthcare Provider Details

I. General information

NPI: 1184923260
Provider Name (Legal Business Name): ADVENTIST BOLINGBROOK HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2011
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 REMINGTON BLVD
BOLINGBROOK IL
60440-4906
US

IV. Provider business mailing address

500 REMINGTON BLVD
BOLINGBROOK IL
60440-4906
US

V. Phone/Fax

Practice location:
  • Phone: 630-312-3970
  • Fax: 630-312-6814
Mailing address:
  • Phone: 630-312-3970
  • Fax: 630-312-6814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054-017593
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TRISTAN SHAW
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 630-312-6008