Healthcare Provider Details

I. General information

NPI: 1902852460
Provider Name (Legal Business Name): RESURRECTION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 10/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7230 W NORTH AVE STE 106B RESURRECTION IMMEDIATE CARE CENTER ELMWOOD PAR
ELMWOOD PARK IL
60707-4262
US

IV. Provider business mailing address

15330 S LA GRANGE RD SUITE 203
ORLAND PARK IL
60462-3885
US

V. Phone/Fax

Practice location:
  • Phone: 708-453-3000
  • Fax: 708-453-4460
Mailing address:
  • Phone: 708-675-8160
  • Fax: 708-364-7474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEAN M. HOBSON
Title or Position: SYSTEM DIRECTOR
Credential:
Phone: 773-797-3603