Provider Demographics
NPI:1215429527
Name:ADVOCATE HEALTH AND HOPSITALS CORPORATION
Entity type:Organization
Organization Name:ADVOCATE HEALTH AND HOPSITALS CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-346-3010
Mailing Address - Street 1:4700 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2533
Mailing Address - Country:US
Mailing Address - Phone:708-346-3010
Mailing Address - Fax:708-346-4868
Practice Address - Street 1:440 QUADRANGLE DR STE K
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-3455
Practice Address - Country:US
Practice Address - Phone:800-216-1110
Practice Address - Fax:708-346-4868
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDHOOD TRAUMA TREATMENT PROGRAM OF ADVOCATE HEALTH & HOSPITALS CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health