Healthcare Provider Details

I. General information

NPI: 1629137849
Provider Name (Legal Business Name): RUSH OAK PARK HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 SOUTH MAPLE AVENUE
OAK PARK IL
60304
US

IV. Provider business mailing address

520 SOUTH MAPLE AVENUE
OAK PARK IL
60304-1097
US

V. Phone/Fax

Practice location:
  • Phone: 708-660-4700
  • Fax: 708-660-4735
Mailing address:
  • Phone: 708-660-6633
  • Fax: 708-660-6658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1744986
License Number StateIL

VIII. Authorized Official

Name: MR. BRUCE M ELEGANT
Title or Position: PRESIDENT CEO
Credential:
Phone: 708-660-6659