=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184630576
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVENTIST GLENOAKS HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2006
-----------------------------------------------------
Last Update Date | 02/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 701 WINTHROP AVE
-----------------------------------------------------
City | GLENDALE HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60139-1405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-545-8275
-----------------------------------------------------
Fax | 630-545-8279
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 701 WINTHROP AVE
-----------------------------------------------------
City | GLENDALE HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60139-1405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-545-8275
-----------------------------------------------------
Fax | 630-545-8279
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | ZACHARY DYE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 630-864-9299
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------