Healthcare Provider Details

I. General information

NPI: 1922142942
Provider Name (Legal Business Name): JOHN J. MADDEN MHC PAV-1, UNIT 4461
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 SOUTH FIRST AVE
HINES IL
60141-7000
US

IV. Provider business mailing address

1200 SOUTH FIRST AVE
HINES IL
60141-7000
US

V. Phone/Fax

Practice location:
  • Phone: 708-338-7048
  • Fax: 708-338-7233
Mailing address:
  • Phone: 708-338-7048
  • Fax: 708-338-7233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number StateIL

VIII. Authorized Official

Name: FRED NIRDE
Title or Position: HOSPITAL ADMINSITRATOR
Credential:
Phone: 708-338-7048