Provider Demographics
NPI:1215246269
Name:RUSH HEALTH AND AGING
Entity type:Organization
Organization Name:RUSH HEALTH AND AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR - AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:312-942-4436
Mailing Address - Street 1:710 S PAULINA ST
Mailing Address - Street 2:SUITE 438
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3808
Mailing Address - Country:US
Mailing Address - Phone:312-563-2702
Mailing Address - Fax:312-942-6116
Practice Address - Street 1:710 S PAULINA ST
Practice Address - Street 2:SUITE 438
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3808
Practice Address - Country:US
Practice Address - Phone:312-563-2702
Practice Address - Fax:312-942-6116
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUSH UNIVERSITY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-24
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty