Provider Demographics
NPI:1386779031
Name:ADVOCATE LUTHERAN GENERAL
Entity type:Organization
Organization Name:ADVOCATE LUTHERAN GENERAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW, CADC
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:OSBORN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CADC
Authorized Official - Phone:847-723-7315
Mailing Address - Street 1:1855 PARKSIDE DR
Mailing Address - Street 2:#3
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1068
Mailing Address - Country:US
Mailing Address - Phone:847-297-0823
Mailing Address - Fax:
Practice Address - Street 1:1775 DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1143
Practice Address - Country:US
Practice Address - Phone:847-723-7315
Practice Address - Fax:847-723-2394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149010267282N00000X
IL21129282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital