=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093241275
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTHWEST COMMUNITY HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2017
-----------------------------------------------------
Last Update Date | 05/05/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2704 ROYAL SAINT GEORGES CT
-----------------------------------------------------
City | SAINT CHARLES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60174-8754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-377-6812
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2704 ROYAL SAINT GEORGES CT
-----------------------------------------------------
City | SAINT CHARLES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60174-8754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-377-6812
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOCIAL WORKER
-----------------------------------------------------
Name | LORRAINE WEBER
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 708-807-6046
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 149.000895
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------