Healthcare Provider Details

I. General information

NPI: 1124025176
Provider Name (Legal Business Name): NORTHWESTERN LAKE FOREST HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2005
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N WESTMORELAND RD
LAKE FOREST IL
60045-1658
US

IV. Provider business mailing address

1000 N WESTMORELAND RD
LAKE FOREST IL
60045-1658
US

V. Phone/Fax

Practice location:
  • Phone: 847-234-5600
  • Fax: 847-535-7846
Mailing address:
  • Phone: 847-234-5600
  • Fax: 847-535-7846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number0001230
License Number StateIL

VIII. Authorized Official

Name: SEAMUS P COLLINS
Title or Position: PRESIDENT
Credential:
Phone: 847-535-8683