Healthcare Provider Details

I. General information

NPI: 1891755351
Provider Name (Legal Business Name): THOREK MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5025 N PAULINA ST
CHICAGO IL
60640-2772
US

IV. Provider business mailing address

5025 N PAULINA ST
CHICAGO IL
60640-2772
US

V. Phone/Fax

Practice location:
  • Phone: 773-271-9040
  • Fax: 773-271-2010
Mailing address:
  • Phone: 773-271-9040
  • Fax: 773-271-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number0000125
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number0000125
License Number StateIL

VIII. Authorized Official

Name: EDWARD BUDD
Title or Position: CEO
Credential:
Phone: 773-975-6705