Organization
PRESENCE HEALTHCARE SERVICES
Active
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
2800 N SHERIDAN RD, SUITE 309, CHICAGO, IL 60657-6156
(773) 871-4183
(773) 883-1202
Mailing address
1000 REMINGTON BOULEVARD, BOLINGBROOK, IL 60440-0000
(630) 914-2417
(630) 914-2499
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
036043445
IL
207RA0201X
Allergy & Immunology (Internal Medicine) Physician
036043445
IL
207RA0201X
Allergy & Immunology (Internal Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036043445
—
IL
Enumeration date
05/19/2011
Last updated
04/10/2013
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