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DSH140304E ADVENTIST BOLINGBROOK HOSPITAL (Terminated)
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Main Details
Name
ADVENTIST BOLINGBROOK HOSPITAL
Subdivision Name
Wound Care Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140304E
Medicare Provider Number
140304
Outpatient Facility Provider Number
140304
Additional Details
Current Program Status
Terminated
Registration Date
7/8/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/4/2014
Last Recertification Date
8/23/2016
Termination Date
Termination Reason
1/1/2018
Site closure
Contacts
Authorizing Official
AdventHealth GlenOaks
Vladimir Radivojevic, President & CEO
(630) 545-7258
Primary Contact
Adventist Bolingbrook Hospital
JODI PONTERIO, MANAGER OF PHARMACY
(630) 312-3965
Addresses
Street Address
420 Schmidt Road
Suite 110
Bolingbrook, IL 60440
Billing Address
Adventist Bolingbrook Hospital
P.O. Box 9245
Oak Brook, IL 60522
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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