Organization
AERIES HEALTHCARE OF ILLINOIS PHYSICIAN GROUP
Active
Parent organization
RIVEREDEGE HOSPITAL
Organization subpart
Yes
Provider details
NPI number
Legal business name
RIVEREDEGE HOSPITAL
Authorized official
MR. MICHAEL NELSON (CFO)
(708) 209-4156
Entity
Organization
Contact information
Practice address
8311 W ROOSEVELT RD, FOREST PARK, IL 60130
(708) 209-4150
Mailing address
PO BOX 840936, DALLAS, TX 72584
(708) 209-4152
Taxonomy
Speciality
Code
Description
License number
State
103TP0016X
Prescribing (Medical) Psychologist
Primary
—
IL
Other
Enumeration date
06/17/2009
Last updated
06/17/2009
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