Provider Demographics
NPI:1962632877
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:630-856-6889
Mailing Address - Street 1:199 S ADDISON RD
Mailing Address - Street 2:STE 108
Mailing Address - City:WOOD DALE
Mailing Address - State:IL
Mailing Address - Zip Code:60191-1929
Mailing Address - Country:US
Mailing Address - Phone:630-616-7223
Mailing Address - Fax:630-616-7224
Practice Address - Street 1:199 S ADDISON RD
Practice Address - Street 2:SUITE 108
Practice Address - City:WOOD DALE
Practice Address - State:IL
Practice Address - Zip Code:60191-1929
Practice Address - Country:US
Practice Address - Phone:630-616-7223
Practice Address - Fax:630-616-7224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-27
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL400480OtherMEDICARE PTAN