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General NPI Number Information
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NPI Number | 1386779031
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Entity Type | Organization
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Legal Business Name | ADVOCATE LUTHERAN GENERAL
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 1775 DEMPSTER ST
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City | PARK RIDGE
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State | IL
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Zip | 60068-1143
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Country | US
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Telephone | 847-723-7315
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Fax | 847-723-2394
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Provider Business Mailing Address
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Address Line | 1855 PARKSIDE DR #3
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City | PARK RIDGE
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State | IL
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Zip | 60068-1068
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Country | US
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Telephone | 847-297-0823
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Fax |
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Authorized Official
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Title or Position | LCSW, CADC
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Name | MS. LISA ELAINE OSBORN
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Credential | LCSW, CADC
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Telephone | 847-723-7315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 149010267
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 21129
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License Number State | IL
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