Provider Demographics
NPI:1588978670
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: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 1:5201 S. WILLOW SPRINGS RD
Mailing Address - Street 2:STE 160
Mailing Address - City:LAGRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525
Mailing Address - Country:US
Mailing Address - Phone:708-354-0920
Mailing Address - Fax:708-354-0974
Practice Address - Street 1:5201 WILLOW SPRINGS RD
Practice Address - Street 2:STE 160
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-6537
Practice Address - Country:US
Practice Address - Phone:708-354-0920
Practice Address - Fax:708-354-0974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-30
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL403270OtherMEDICARE GROUP PTAN