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General NPI Number Information
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NPI Number | 1235224908
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Entity Type | Organization
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Legal Business Name | RUSH UNIVERSITY MEDICAL CENTER
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 01/22/2008
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Provider Practice Location Address
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Address Line | 2001 BUTTERFIELD RD SUITE 320
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-1050
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Country | US
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Telephone | 312-563-3623
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Fax | 312-563-3701
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Provider Business Mailing Address
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Address Line | 2001 BUTTERFIELD RD SUITE 320
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-1050
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Country | US
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Telephone | 131-256-3362
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Fax | 312-563-3701
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. CARL L. ANDERSON
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Credential | M.S.
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Telephone | 312-563-3593
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | A-9210-0002-A
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License Number State | IL
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