Provider Demographics
NPI:1487781142
Name:LOYOLA UNIVERSITY MEDICAL CTR., HOME INFUSION
Entity type:Organization
Organization Name:LOYOLA UNIVERSITY MEDICAL CTR., HOME INFUSION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:ARRIAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-216-4039
Mailing Address - Street 1:2160 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-3328
Mailing Address - Country:US
Mailing Address - Phone:708-216-4552
Mailing Address - Fax:708-216-6112
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-3328
Practice Address - Country:US
Practice Address - Phone:708-216-4552
Practice Address - Fax:708-216-6112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9729OtherCOMMERCIAL INS HOMECARE
IL9729OtherBCBS HOMEINFUSION CARE
IL=========011Medicaid
IL9729OtherBCBS HOMEINFUSION CARE