Healthcare Provider Details

I. General information

NPI: 1003976713
Provider Name (Legal Business Name): PRESENCE CENTRAL AND SUBURBAN HOSPITALS NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 MADISON ST
JOLIET IL
60435-8200
US

IV. Provider business mailing address

333 MADISON ST
JOLIET IL
60435-8200
US

V. Phone/Fax

Practice location:
  • Phone: 815-725-7133
  • Fax:
Mailing address:
  • Phone: 815-725-7133
  • Fax: 815-741-7579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number0004838
License Number StateIL

VIII. Authorized Official

Name: RICHARD DOUGLAS CARTER
Title or Position: AMITA CFO
Credential:
Phone: 224-273-2350