Healthcare Provider Details

I. General information

NPI: 1033272273
Provider Name (Legal Business Name): LA RABIDA CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E. 87TH STREET SUITE 800
CHICAGO IL
60619-7011
US

IV. Provider business mailing address

1111 E. 87TH STREET SUITE 800
CHICAGO IL
60619-7011
US

V. Phone/Fax

Practice location:
  • Phone: 773-374-3748
  • Fax: 773-374-6223
Mailing address:
  • Phone: 773-374-3748
  • Fax: 773-374-6223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281PC2000X
TaxonomyChildren's Chronic Disease Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK RENFREE
Title or Position: CFO & VP OF ADMINISTRATION
Credential:
Phone: 773-753-8630