Organization
WESTMINSTER PLACE
Active
Other names
Presbyterian Homes
Organization subpart
No
Provider details
NPI number
Authorized official
MARK HAVRILKA (CHIEF FINANCIAL OFFICER)
(847) 979-3904
Entity
Organization
Contact information
Practice address
3200 GRANT STREET, EVANSTON, IL 60201
(847) 492-4828
(847) 492-4810
Mailing address
8707 SKOKIE BLVD STE 400, SKOKIE, IL 60077-2283
(847) 979-3955
(847) 979-3969
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1633224
BLUE CROSS BLUE SHIELD OF ILLINOIS
IL
Enumeration date
03/28/2006
Last updated
10/14/2022
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