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General NPI Number Information
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NPI Number | 1417202839
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Entity Type | Organization
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Legal Business Name | CAPTAIN JAMES A. LOVELL FEDERAL HEALTH CARE CENTER
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Dates
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Enumeration Date | 07/23/2012
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Last Update Date | 07/23/2012
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Provider Practice Location Address
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Address Line | 3001 GREEN BAY RD
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City | NORTH CHICAGO
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State | IL
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Zip | 60064-3048
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Country | US
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Telephone | 847-877-9238
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Fax |
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Provider Business Mailing Address
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Address Line | 3001 GREEN BAY RD
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City | NORTH CHICAGO
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State | IL
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Zip | 60064-3048
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Country | US
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Telephone | 847-877-9238
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | JACQUELINE LEE MAROLT
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Credential | LCSW
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Telephone | 847-877-9238
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 286500000X
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Taxonomy Name | Military Hospital
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License Number | 149.015260
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License Number State | IL
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