Healthcare Provider Details

I. General information

NPI: 1528112224
Provider Name (Legal Business Name): SAINT JOSEPH HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 N OAKLEY BLVD 4TH FLOOR
CHICAGO IL
60622-3507
US

IV. Provider business mailing address

2900 N LAKE SHORE DR
CHICAGO IL
60657-5640
US

V. Phone/Fax

Practice location:
  • Phone: 773-572-8500
  • Fax: 773-572-8568
Mailing address:
  • Phone: 773-665-3317
  • Fax: 773-665-3460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number8000051
License Number StateIL

VIII. Authorized Official

Name: MRS. SUSAN PFISTER
Title or Position: SYSTEM DIRECTOR, PFS
Credential:
Phone: 773-792-9903