Healthcare Provider Details

I. General information

NPI: 1588739734
Provider Name (Legal Business Name): SWEDISH COVENANT HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5140 N CALIFORNIA AVE G-105
CHICAGO IL
60625-3645
US

IV. Provider business mailing address

5140 N CALIFORNIA AVE G-105
CHICAGO IL
60625-3645
US

V. Phone/Fax

Practice location:
  • Phone: 773-989-3980
  • Fax: 773-989-6285
Mailing address:
  • Phone: 773-989-3980
  • Fax: 773-989-6285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054015358
License Number StateIL

VIII. Authorized Official

Name: ELLEN DANIEL
Title or Position: AVP ASST CONTROLLER
Credential:
Phone: 847-570-5103