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General NPI Number Information
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NPI Number | 1366555245
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Entity Type | Organization
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Legal Business Name | GOTTLIEB MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 701 W NORTH AVE
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City | MELROSE PARK
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State | IL
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Zip | 60160-1612
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Country | US
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Telephone | 708-681-3200
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Fax | 708-450-5058
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Provider Business Mailing Address
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Address Line | 701 W NORTH AVE
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City | MELROSE PARK
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State | IL
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Zip | 60160-1612
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Country | US
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Telephone | 708-681-3200
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Fax | 708-450-5058
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. ELIZABETH EARLY
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Credential |
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Telephone | 708-538-6920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 0005561
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License Number State | IL
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