MEDICARE: PRESENCE CHICAGO HOSPITALS NETWORK

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
1	273Y00000X	Rehabilitation Hospital Unit

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0415	OTHER	IL	IL BX PROVIDER NUMBER

General Provider Information

NPI Number	:	1184703019
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESENCE CHICAGO HOSPITALS NETWORK

Provider Business Mailing Address
First Line	:	2900 N LAKE SHORE DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5640
Country	:	US
Telephone Number	:	773-665-3081
Fax Number	:	773-665-3460

Provider Business Practice Location Address
First Line	:	1127 N OAKLEY BLVD
Second Line	:	4TH FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60622-3507
Country	:	US
Telephone Number	:	773-572-8500
Fax Number	:	773-572-8568

Authorized Official
Title or Position	:	VP FINANCE
Name	:	LISA E NEUMAN
Credential	:
Telephone Number	:	224-273-0516

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	01/01/2022

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