Healthcare Provider Details

I. General information

NPI: 1518982396
Provider Name (Legal Business Name): EDWARD HINES JUNIOR VETERANS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FIFTH AVENUE AT ROOSEVELT ROAD ROUTE 116A3
HINES IL
60141
US

IV. Provider business mailing address

FIFTH AVENUE AT ROOSEVELT ROAD ROUTE 116A3
HINES IL
60141
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-8387
  • Fax: 708-202-2024
Mailing address:
  • Phone: 708-202-8387
  • Fax: 708-202-2024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number
License Number StateIL

VIII. Authorized Official

Name: MRS. KATHLEEN REGINA FOLEY
Title or Position: CLINICAL NURSE SPECIALIST
Credential: RN, APN
Phone: 708-202-8387