Organization
HINES VA HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACALYN R LYLES-CARROLL (CRT)
(708) 202-8387
Entity
Organization
Contact information
Practice address
5923 RIDGE AVE, BERKELEY, IL 60163-1545
(708) 202-8387
Mailing address
5923 RIDGE AVE, BERKELEY, IL 60163-1545
(708) 202-8387
Taxonomy
Speciality
Code
Description
License number
State
286500000X
Military Hospital
Primary
—
IL
Other
Enumeration date
03/06/2007
Last updated
08/22/2020
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