Healthcare Provider Details

I. General information

NPI: 1396703088
Provider Name (Legal Business Name): CENTRAL DUPAGE SPECIAL HEALTH ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26W171 ROOSEVELT RD RM G021
WHEATON IL
60187-6002
US

IV. Provider business mailing address

26W171 ROOSEVELT RD RM G021
WHEATON IL
60187-6002
US

V. Phone/Fax

Practice location:
  • Phone: 630-933-7777
  • Fax: 630-588-8403
Mailing address:
  • Phone: 630-933-7777
  • Fax: 630-588-8403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number093013424
License Number StateIL

VIII. Authorized Official

Name: MS. MAURA O'TOOLE
Title or Position: VICE PRESIDENT OPERATIONS
Credential:
Phone: 630-933-6983