St Mary of Providence
St Mary of Providence is an Intellectual Disabilities Intermediate Care Facility in Chicago, Illinois. Licensed in Illinois. Registered with an NPI since 2008.
- Licensed in
- IL
- In the registry since
- 2008
Practice location Address checks out
4200 N Austin AveChicago, IL 60634-1615
Phone: (773) 545-8300
Fax: (773) 545-2984
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Specialties & licences
| Intellectual Disabilities Intermediate Care Facility (primary) | Taxonomy 315P00000X · Licence 0033761 (IL) |
|---|
Record details
| NPI number | 1588842470 |
|---|---|
| Entity type | Organization (Type 2) |
| Organization subpart | Yes |
| Parent organization | St Mary of Providence |
| Authorized official | Rita Butler — Director · (773) 545-8300 |
| Other names | Rose Angela Hall |
| NPI enumerated | February 4, 2008 |
| Last updated in NPPES | February 4, 2008 |
| Mailing address | 4200 N Austin Ave, Chicago, IL 60634-1615 |
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