Provider Demographics
NPI:1427118439
Name:OAKSIDE CORPORATION
Entity type:Organization
Organization Name:OAKSIDE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:815-933-2240
Mailing Address - Street 1:1905 W COURT ST
Mailing Address - Street 2:ENTRANCE A
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3163
Mailing Address - Country:US
Mailing Address - Phone:815-933-2240
Mailing Address - Fax:815-935-7261
Practice Address - Street 1:1905 W COURT ST
Practice Address - Street 2:ENTRANCE A
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3163
Practice Address - Country:US
Practice Address - Phone:815-933-2240
Practice Address - Fax:815-935-7261
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIVERSIDE HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-11
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)