Healthcare Provider Details

I. General information

NPI: 1669617007
Provider Name (Legal Business Name): ALIVIO MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2008
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 S. MARSHALL BLVD
CHICAGO IL
60623-4146
US

IV. Provider business mailing address

966 W. 21ST STREET
CHICAGO IL
60608-4511
US

V. Phone/Fax

Practice location:
  • Phone: 773-254-1400
  • Fax:
Mailing address:
  • Phone: 773-254-1400
  • Fax: 312-829-6673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: MRS. ESTHER CORPUZ
Title or Position: CEO
Credential:
Phone: 312-829-6304