Provider Demographics
NPI:1104940329
Name:RESURRECTION SERVICES
Entity type:Organization
Organization Name:RESURRECTION SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SYSTEM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-797-3603
Mailing Address - Street 1:15330 S LA GRANGE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-3885
Mailing Address - Country:US
Mailing Address - Phone:708-675-8160
Mailing Address - Fax:708-364-7474
Practice Address - Street 1:420 WILLIAM STREET
Practice Address - Street 2:1ST FLOOR
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1920
Practice Address - Country:US
Practice Address - Phone:708-488-2300
Practice Address - Fax:708-488-2302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1619414OtherBCBS GROUP
IL140049OtherHOSPITAL MC GROUP NUMBER
IL1390Medicare PIN