Organization
JACKSON PARK HOSPITAL FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MERRITT J. HASBROUCK (PRESIDENT)
(773) 947-7500
Entity
Organization
Contact information
Practice address
7531 S STONY ISLAND AVE, CHICAGO, IL 60649-3954
(773) 947-7500
(773) 947-7339
Mailing address
7531 S STONY ISLAND AVE, CHICAGO, IL 60649-3954
(773) 947-7500
(773) 947-7339
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
0001115
IL
282N00000X
General Acute Care Hospital
Primary
0001115
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0026
BLUECROSS
IL
Enumeration date
06/15/2005
Last updated
01/28/2020
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