Healthcare Provider Details

I. General information

NPI: 1831194182
Provider Name (Legal Business Name): FRANCISCAN HEALTH DYER & HAMMOND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 11/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3224 RIDGE RD STE 202&203
LANSING IL
60438-3129
US

IV. Provider business mailing address

3224 RIDGE RD STE 202&203
LANSING IL
60438-3129
US

V. Phone/Fax

Practice location:
  • Phone: 708-418-5543
  • Fax: 708-418-8005
Mailing address:
  • Phone: 708-418-5543
  • Fax: 708-418-8005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1010198
License Number StateIL

VIII. Authorized Official

Name: MR. JOSEPH M GOLAN
Title or Position: CFO
Credential:
Phone: 219-932-2300