Organization Name: | BONAVENTURE MEDICAL FOUNDATION |
NPI Number: | 1083960108 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARGARET ROSE CONNOR (REG. DIETITIAN/PROGRAM COORDINATOR) |
Mailing Address: | 864 W Stearns Rd Suite 106 Bartlett |
State: | IL US |
Postal Code: | 601034800 |
Phone Number: | 8472526098 |
Fax Number: | |
NPI Enumeration Date: | 07/26/2012 |
NPI Last Update Date: | 07/26/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM2500X |
License Number: | 164005616 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Medical Specialty |
Taxonomy Definition: | An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |