Provider Demographics
NPI:1871977751
Name:GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION
Entity type:Organization
Organization Name:GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR BILLING OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ADENRELE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLAWOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-216-3743
Mailing Address - Street 1:3249 OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3429
Mailing Address - Country:US
Mailing Address - Phone:708-216-0378
Mailing Address - Fax:
Practice Address - Street 1:3249 OAK PARK AVE
Practice Address - Street 2:22 NORTH
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402
Practice Address - Country:US
Practice Address - Phone:708-783-3456
Practice Address - Fax:708-783-2167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-10
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14T054Medicare Oscar/Certification