Healthcare Provider Details

I. General information

NPI: 1437481504
Provider Name (Legal Business Name): ST JAMES HOSPITAL US CATHOLIC CONFERENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2010
Last Update Date: 02/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20201 CRAWFORD AVE
OLYMPIA FIELDS IL
60461-1010
US

IV. Provider business mailing address

30 E 15TH ST SUITE 406
CHICAGO HEIGHTS IL
60411-3459
US

V. Phone/Fax

Practice location:
  • Phone: 708-755-3348
  • Fax: 708-755-3393
Mailing address:
  • Phone: 708-755-3348
  • Fax: 708-755-3393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number1744997
License Number StateIL

VIII. Authorized Official

Name: MRS. DEANNA MARIE BASS
Title or Position: ACCOUNT REPRESENTATIVE
Credential:
Phone: 708-755-3348