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General NPI Number Information
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NPI Number | 1861774408
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Entity Type | Organization
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Legal Business Name | ADVOCATE NORTHSIDE HEALTH SYSTEM
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Dates
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Enumeration Date | 09/09/2011
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Last Update Date | 02/21/2023
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Provider Practice Location Address
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Address Line | 913 W WELLINGTON AVE FL 2
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City | CHICAGO
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State | IL
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Zip | 60657-6709
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Country | US
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Telephone | 873-843-0200
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Fax |
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Provider Business Mailing Address
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Address Line | 21312 NETWORK PL
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City | CHICAGO
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State | IL
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Zip | 60673-1223
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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 | SENIOR BUSINESS ANALYST
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Name | PAUL ANDERSON
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Credential |
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Telephone | 773-296-6316
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 04004
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License Number State | IL
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