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NPI Code Detail

MEDICARE: GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION

MEDICARE: GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1282N00000XGeneral Acute Care Hospital0005561IL

General Provider Information

NPI Number : 1043292428
Entity Type Code : Organization
Provider Name (Legal Business Name) : GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION
Provider Business Mailing Address
First Line : 2160 S 1ST AVE BLDG 102
Second Line :
City : MAYWOOD
State : IL
Zip : 60153-3328
Country : US
Telephone Number : 708-216-8686
Fax Number : 708-216-8059
Provider Business Practice Location Address
First Line : 3249 OAK PARK AVE
Second Line :
City : BERWYN
State : IL
Zip : 60402-3429
Country : US
Telephone Number : 708-783-3125
Fax Number : 708-216-8059
Authorized Official
Title or Position : DIRECTOR BILLING OPERATIONS
Name : ADENRELE KOLAWOLE
Credential :
Telephone Number : 708-216-3743
Provider Enumeration Date : 11/18/2005
Last Update Date : 12/16/2019

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Directions to “GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION ” Practice Location

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