Healthcare Provider Details

I. General information

NPI: 1366487936
Provider Name (Legal Business Name): ADVENTIST HEALTH PARTNERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 06/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6438 JOLIET RD
COUNTRYSIDE IL
60525-4685
US

IV. Provider business mailing address

6438 JOLIET RD
COUNTRYSIDE IL
60525-4685
US

V. Phone/Fax

Practice location:
  • Phone: 708-352-5222
  • Fax: 708-352-5285
Mailing address:
  • Phone: 708-352-5222
  • Fax: 708-352-5285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. RUBY MANN
Title or Position: DIRECTOR OF MANAGED CARE
Credential:
Phone: 630-856-6884