Healthcare Provider Details

I. General information

NPI: 1588856603
Provider Name (Legal Business Name): ELMHURST MEMORIAL HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 E SCHILLER ST
ELMHURST IL
60126-2816
US

IV. Provider business mailing address

172 SCHILLER
ELMHURST IL
60126-2885
US

V. Phone/Fax

Practice location:
  • Phone: 630-834-1120
  • Fax: 630-993-5681
Mailing address:
  • Phone: 331-221-9053
  • Fax: 630-758-9940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. DONALD R LURYE
Title or Position: CEO
Credential: MD
Phone: 331-221-9053