Organization
PRESENCE HEALTHCARE SERVICES
Active
Other names
Resurrection Services
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MELVONNE WICKLIFFE-JONES (CREDENTIALING MGR)
(630) 914-2417
Entity
Organization
Contact information
Practice address
1431 N WESTERN AVE, SUITE 134, CHICAGO, IL 60622-1797
(773) 235-1915
(773) 235-1999
Mailing address
1000 REMINGTON BOULEVARD, BOLINGBROOK, IL 60440-0000
(630) 914-2417
(630) 914-2499
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
—
IL
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
745367
MEDICARE PTAN
IL
Enumeration date
08/11/2011
Last updated
04/10/2013
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