NPIMap

Organization Active NPI

Gottlieb Memorial Hospital

  • Community Based Hospice Care Agency
  • Melrose Park, IL
National Provider Identifier
1225141104
Registry record updated Apr 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
0005561 Issued in IL
Legal business name
GOTTLIEB MEMORIAL HOSPITAL
Practice address
701 West North Avenue
Melrose Park, IL 60160-1602
Phone
(708) 216-4983
Fax
(708) 216-0808
NPI assigned
Aug 16, 2006
Last updated
Apr 29, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
GOTTLIEB MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 29, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Ajay S. Sial
Title
Treasurer
Phone
(708) 216-4252

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 0005561 IL Primary

Addresses

Primary practice location

701 West North Avenue
Melrose Park, IL 60160-1602

Mailing address

701 West North Avenue
Melrose Park, IL 60160-1602
Phone (708) 681-3200

Other identifiers 1

IdentifierTypeStateIssuer
9559OtherILBLUE CROSS

Other names 1

  • Gottlieb Hospice Program Other name

National Provider Directory

National Provider Directory
Part of
Gottlieb Mem Medical SE

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

905 W North Ave
Melrose Park, IL 60160
Phone (708) 216-4983

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398729600000",
    "number": "1225141104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 WEST NORTH AVENUE",
            "city": "MELROSE PARK",
            "state": "IL",
            "postal_code": "601601602",
            "telephone_number": "708-681-3200",
            "fax_number": "708-450-5058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 WEST NORTH AVENUE",
            "city": "MELROSE PARK",
            "state": "IL",
            "postal_code": "601601602",
            "telephone_number": "708-216-4983",
            "fax_number": "708-216-0808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOTTLIEB MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GOTTLIEB MEMORIAL HOSPITAL",
        "enumeration_date": "2006-08-16",
        "last_updated": "2014-04-29",
        "status": "A",
        "authorized_official_last_name": "SIAL",
        "authorized_official_first_name": "AJAY",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "708-216-4252",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "IL",
            "license": "0005561",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "9559",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gottlieb Hospice Program",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Melrose Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.