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General NPI Number Information
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NPI Number | 1770504789
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Entity Type | Organization
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Legal Business Name | NORTHWEST SUBURBAN COMMUNITY HOSPITAL
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1625 S STATE ST
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City | BELVIDERE
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State | IL
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Zip | 61008-5907
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Country | US
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Telephone | 815-547-5441
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Fax | 815-544-0517
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Provider Business Mailing Address
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Address Line | 135 S PROSPECT ST
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City | YPSILANTI
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State | MI
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Zip | 48198-7914
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Country | US
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Telephone | 734-547-1114
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Fax | 734-547-1145
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT
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Name | MR. LAURENCE HENRY LENZ JR.
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Credential |
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Telephone | 734-547-1114
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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 | 0004820
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License Number State | IL
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