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General NPI Number Information
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NPI Number | 1043816515
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Entity Type | Organization
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Legal Business Name | NEW ROSE HEALTHCARE MANAGEMENT LLC
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Dates
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Enumeration Date | 12/09/2020
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Last Update Date | 02/04/2021
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Provider Practice Location Address
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Address Line | 45 W 111TH ST
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City | CHICAGO
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State | IL
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Zip | 60628-4200
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Country | US
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Telephone | 773-995-3000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7167
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City | CAROL STREAM
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State | IL
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Zip | 60197-7167
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Country | US
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Telephone | 773-995-3000
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TIMOTHY EGAN
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Credential |
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Telephone | 773-995-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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