Provider Demographics
NPI:1538264148
Name:RESURRECTION HEALTH CARE PREFERRED
Entity type:Organization
Organization Name:RESURRECTION HEALTH CARE PREFERRED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LENORE
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:KANARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-316-4719
Mailing Address - Street 1:355 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3328
Mailing Address - Country:US
Mailing Address - Phone:847-316-4719
Mailing Address - Fax:847-316-6346
Practice Address - Street 1:7345 W TALCOTT AVE
Practice Address - Street 2:FINANCE DEPARTMENT
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3706
Practice Address - Country:US
Practice Address - Phone:773-792-5115
Practice Address - Fax:773-549-8567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization