Healthcare Provider Details

I. General information

NPI: 1255573622
Provider Name (Legal Business Name): ADVENTIST HEALTH PARTNERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 11/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 95TH ST STE 3
NAPERVILLE IL
60564-5040
US

IV. Provider business mailing address

1012 95TH ST STE 3
NAPERVILLE IL
60564-5040
US

V. Phone/Fax

Practice location:
  • Phone: 630-856-8790
  • Fax: 630-428-3848
Mailing address:
  • Phone: 630-856-8790
  • Fax: 630-428-3848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. RUBY MANN
Title or Position: DIRECTOR
Credential:
Phone: 630-856-6884