Healthcare Provider Details

I. General information

NPI: 1649515735
Provider Name (Legal Business Name): PRESENCE HOLY FAMILY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2012
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N. RIVER ROAD
DES PLAINES IL
60016-0000
US

IV. Provider business mailing address

1000 REMINGTON BLVD SUITE 100
BOLLINGBROOK IL
60440-0000
US

V. Phone/Fax

Practice location:
  • Phone: 847-297-1800
  • Fax:
Mailing address:
  • Phone: 630-914-2417
  • Fax: 630-914-2499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number056007151
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MRS. MELVONNE WICKLIFFE-JONES
Title or Position: CREDENTIALING MGR
Credential:
Phone: 630-914-2417