Healthcare Provider Details

I. General information

NPI: 1912470394
Provider Name (Legal Business Name): RESILIENCE HEALTHCARE-WEST SUBURBAN MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7420 CENTRAL AVE
RIVER FOREST IL
60305-1800
US

IV. Provider business mailing address

3 ERIE CT
OAK PARK IL
60302-2519
US

V. Phone/Fax

Practice location:
  • Phone: 708-763-2734
  • Fax:
Mailing address:
  • Phone: 708-383-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. MANOJ PRASAD
Title or Position: CEO
Credential: MD
Phone: 708-763-6700