MEDICARE: ROSELAND COMMUNITY HOSPITAL ASSOCIATION

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	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician
2	273R00000X	Psychiatric Hospital Unit	0002063	IL
3	283Q00000X	Psychiatric Hospital	0002063	IL
4	332B00000X	Durable Medical Equipment & Medical Supplies	0002063	IL
5	282N00000X	General Acute Care Hospital	0002063	IL

General Provider Information

NPI Number	:	1568472819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSELAND COMMUNITY HOSPITAL ASSOCIATION

Provider Business Mailing Address
First Line	:	45 W 111TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60628-4200
Country	:	US
Telephone Number	:	773-995-3000
Fax Number	:	773-995-6602

Provider Business Practice Location Address
First Line	:	45 W 111TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60628-4200
Country	:	US
Telephone Number	:	773-995-3000
Fax Number	:	773-995-6602

Authorized Official
Title or Position	:	CEO
Name	:	MR. TIM EGAN
Credential	:
Telephone Number	:	773-995-3000

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	11/27/2023

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