Healthcare Provider Details

I. General information

NPI: 1710070701
Provider Name (Legal Business Name): RIVEREDGE HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 03/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8311 ROOSEVELT RD
FOREST PARK IL
60130-2529
US

IV. Provider business mailing address

8311 ROOSEVELT RD
FOREST PARK IL
60130-2529
US

V. Phone/Fax

Practice location:
  • Phone: 708-771-7000
  • Fax: 708-209-2280
Mailing address:
  • Phone: 708-771-7000
  • Fax: 708-209-2280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number0005124
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number1720146
License Number StateIL

VIII. Authorized Official

Name: STEVE FILTON
Title or Position: SR VP CFO
Credential:
Phone: 417-274-9038