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General NPI Number Information
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NPI Number | 1801132105
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Entity Type | Organization
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Legal Business Name | INGALLS MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 12/14/2012
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Last Update Date | 12/14/2012
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Provider Practice Location Address
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Address Line | 15620 WOOD ST
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City | HARVEY
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State | IL
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Zip | 60426-4171
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Country | US
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Telephone | 708-915-4229
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Fax |
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Provider Business Mailing Address
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Address Line | 15620 WOOD ST
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City | HARVEY
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State | IL
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Zip | 60426-4171
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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 | CEO
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Name | CURT JOHNSON
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Credential |
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Telephone | 708-333-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 146002609
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 146002609
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 146002609
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 146002609
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 146002609
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License Number State | IL
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Taxonomy #6
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Taxonomy Code | 283X00000X
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Taxonomy Name | Rehabilitation Hospital
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License Number | 146002609
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License Number State | IL
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