Healthcare Provider Details

I. General information

NPI: 1295869071
Provider Name (Legal Business Name): RESURRECTION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 10/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 WILLIAM STREET 2ND FLOOR
RIVER FOREST IL
60305-1920
US

IV. Provider business mailing address

15330 S LA GRANGE RD SUITE 203
ORLAND PARK IL
60462-3885
US

V. Phone/Fax

Practice location:
  • Phone: 708-763-4727
  • Fax: 708-763-2781
Mailing address:
  • Phone: 708-675-8160
  • Fax: 708-364-7474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: DEAN M. HOBSON
Title or Position: SYSTEM DIRECTOR PATIENT FINANCIAL S
Credential:
Phone: 773-797-3603