Healthcare Provider Details

I. General information

NPI: 1346592664
Provider Name (Legal Business Name): ADVENTIST HEALTH PARTNERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 06/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6283 S ARCHER AVE
CHICAGO IL
60638-2505
US

IV. Provider business mailing address

6283 S ARCHER AVE
CHICAGO IL
60638-2505
US

V. Phone/Fax

Practice location:
  • Phone: 773-585-3131
  • Fax: 773-585-4565
Mailing address:
  • Phone: 773-585-3131
  • Fax: 773-585-4565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. RUBY MANN
Title or Position: DIRECTOR
Credential:
Phone: 630-856-6844