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General NPI Number Information
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NPI Number | 1558957324
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Entity Type | Individual
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Provider Name | REUBEN C HADZIDE REGISTERED NURSE, RN
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Gender | Male
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Dates
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Enumeration Date | 12/16/2020
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Last Update Date | 12/06/2023
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Provider Practice Location Address
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Address Line | 20200 GOVERNORS DR STE 204
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City | OLYMPIA FIELDS
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State | IL
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Zip | 60461-1056
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Country | US
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Telephone | 708-991-7126
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Fax | 312-229-0067
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Provider Business Mailing Address
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Address Line | 5291 PROVIDENCE DR.
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City | MATTESON
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State | IL
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Zip | 60443
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 041.270574
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License Number State | IL
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