Provider Demographics
NPI:1386912046
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
Authorized Official - Prefix:
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 1:1012 95TH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-5041
Mailing Address - Country:US
Mailing Address - Phone:630-856-8670
Mailing Address - Fax:630-548-3421
Practice Address - Street 1:1012 95TH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-5041
Practice Address - Country:US
Practice Address - Phone:630-856-8670
Practice Address - Fax:630-548-3421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
400280OtherMEDICARE PTAN