Provider Demographics
NPI:1427146430
Name:LA RABIDA CHILDREN'S HOSPITAL
Entity type:Organization
Organization Name:LA RABIDA CHILDREN'S HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROLLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, MA
Authorized Official - Phone:773-753-8631
Mailing Address - Street 1:6501 SOUTH PROMONTORY DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649
Mailing Address - Country:US
Mailing Address - Phone:773-363-6700
Mailing Address - Fax:773-363-6774
Practice Address - Street 1:6501 SOUTH PROMONTORY DRIVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649
Practice Address - Country:US
Practice Address - Phone:773-363-6700
Practice Address - Fax:773-363-6774
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LA RABIDA CHILDREN'S HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-11
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0003012281PC2000X
IL282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
No281PC2000XHospitalsChronic Disease HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100275950AOtherINDIANA MEDICAID
IL0160OtherBLUE CROSS
IL143301Medicare UPIN