Provider Demographics
NPI:1972594877
Name:HUMBOLDT PARK HEALTH
Entity type:Organization
Organization Name:HUMBOLDT PARK HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:CHERYL
Authorized Official - Last Name:ERINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-244-5256
Mailing Address - Street 1:1044 NORTH FRANCISCO
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622
Mailing Address - Country:US
Mailing Address - Phone:773-292-8200
Mailing Address - Fax:773-278-3899
Practice Address - Street 1:1044 NORTH FRANCISCO
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622
Practice Address - Country:US
Practice Address - Phone:773-292-8200
Practice Address - Fax:773-278-3899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL273R00000X, 282N00000X
282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL945300Medicare PIN
IL209898Medicare PIN
IL14S206Medicare PIN
IL945301Medicare PIN
IL140206Medicare PIN
IL945300Medicare PIN