MEDICARE: THE EVANGELICAL ALLIANCE MISSION

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	251V00000X	Voluntary or Charitable Agency	041.152199	IL

General Provider Information

NPI Number	:	1578878468
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE EVANGELICAL ALLIANCE MISSION

Provider Business Mailing Address
First Line	:	400 S MAIN PL
Second Line	:
City	:	CAROL STREAM
State	:	IL
Zip	:	60188-2407
Country	:	US
Telephone Number	:	630-653-5300
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 S MAIN PL
Second Line	:
City	:	CAROL STREAM
State	:	IL
Zip	:	60188-2407
Country	:	US
Telephone Number	:	630-653-5300
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MR. ELMER LORENZ
Credential	:
Telephone Number	:	630-653-5300

Provider Enumeration Date	:	08/16/2010
Last Update Date	:	09/14/2010

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Directions to “THE EVANGELICAL ALLIANCE MISSION ” Practice Location

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