Provider Demographics
NPI:1306889654
Name:ADVENTIST HEALTH PARTNERS, INC
Entity type:Organization
Organization Name:ADVENTIST HEALTH PARTNERS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-856-6884
Mailing Address - Street 1:251 N CASS AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1744
Mailing Address - Country:US
Mailing Address - Phone:630-963-0309
Mailing Address - Fax:630-963-0319
Practice Address - Street 1:251 N CASS AVE
Practice Address - Street 2:STE 100
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1744
Practice Address - Country:US
Practice Address - Phone:630-963-0309
Practice Address - Fax:630-963-0319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCN4921OtherRRMC
IL399690Medicare ID - Type Unspecified