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General NPI Number Information
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NPI Number | 1710362991
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Entity Type | Organization
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Legal Business Name | ADVOCATE GOOD SAMARITAN HOSPITAL
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Dates
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Enumeration Date | 07/29/2015
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Last Update Date | 07/29/2015
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Provider Practice Location Address
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Address Line | 3743 HIGHLAND AVE
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-1594
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Country | US
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Telephone | 630-275-6300
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Fax |
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Provider Business Mailing Address
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Address Line | 3743 HIGHLAND AVE
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-1594
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Country | US
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Telephone | 630-275-6300
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Fax |
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Authorized Official
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Title or Position | MANAGER, OUTPATIENT BEHAVIORAL HLTH
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Name | CHERYL MAYER
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Credential | M.S.
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Telephone | 630-275-3773
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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 | 180008332
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License Number State | IL
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