Organization
COOK COUNTY
Active
Other names
PROVIDENT HOSPITAL FFS
Organization subpart
No
Provider details
NPI number
Authorized official
WALENA VALENCIA (CFO)
(312) 572-1202
Entity
Organization
Contact information
Practice address
500 E 51ST ST, CHICAGO, IL 60615-2400
(312) 572-1202
Mailing address
1110 S OAKLEY BLVD, ROOM 200, CHICAGO, IL 60612-4218
(312) 864-4665
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
0004549
IL
Other
Enumeration date
03/30/2007
Last updated
08/22/2020
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