Healthcare Provider Details

I. General information

NPI: 1730589946
Provider Name (Legal Business Name): PRESENCE ST JOSEPH HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N LAKE SHORE DR SUITE 203, MEDICAL EDUCATION BUILDING
CHICAGO IL
60657-5640
US

IV. Provider business mailing address

2900 N LAKE SHORE DR SUITE 203, MEDICAL EDUCATION BUILDING
CHICAGO IL
60657-5640
US

V. Phone/Fax

Practice location:
  • Phone: 773-665-3022
  • Fax: 773-665-3228
Mailing address:
  • Phone: 773-665-3022
  • Fax: 773-665-3228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number StateIL

VIII. Authorized Official

Name: MS. TRISH BOSKOVIK
Title or Position: MEDICAL EDUCATION COORDINATOR
Credential:
Phone: 773-665-3022