| Organization Name: | PROVIDENT HOSPITAL OF COOK COUNTY |
| NPI Number: | 1104842343 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY ABRAHAM (PHYSICIAN) |
| Mailing Address: | 500 E 51st St Chicago |
| State: | IL US |
| Postal Code: | 606152400 |
| Phone Number: | 3125722000 |
| Fax Number: | 3125722595 |
| NPI Enumeration Date: | 07/14/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 275N00000X |
| License Number: | 03681558 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Hospital Units |
| Taxonomy Classification: | Medicare Defined Swing Bed Unit |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A unit of a hospital that has a Medicare provider agreement and has been granted approval from HCFA to provide post-hospital extended care services and be reimbursed as a swing-bed unit. |