Healthcare Provider Details

I. General information

NPI: 1225381106
Provider Name (Legal Business Name): RIVEREDGE HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8311 W ROOSEVELT ROAD
FOREST PARK IL
60130
US

IV. Provider business mailing address

8311 W ROOSEVELT ROAD
FOREST PARK IL
60130
US

V. Phone/Fax

Practice location:
  • Phone: 708-771-7000
  • Fax: 708-209-2292
Mailing address:
  • Phone: 708-771-7000
  • Fax: 708-209-2292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: STEVE FILTON
Title or Position: VICE PRESIDENT
Credential:
Phone: 610-768-3482