Healthcare Provider Details

I. General information

NPI: 1538264148
Provider Name (Legal Business Name): RESURRECTION HEALTH CARE PREFERRED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7345 W TALCOTT AVE FINANCE DEPARTMENT
CHICAGO IL
60631-3706
US

IV. Provider business mailing address

355 RIDGE AVE
EVANSTON IL
60202-3328
US

V. Phone/Fax

Practice location:
  • Phone: 773-792-5115
  • Fax: 773-549-8567
Mailing address:
  • Phone: 847-316-4719
  • Fax: 847-316-6346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MS. LENORE RUTH KANARY
Title or Position: DIRECTOR
Credential:
Phone: 847-316-4719