St. Mary Of Providence - Chicago, IL

St. Mary Of Providence

Intellectual Disabilities Intermediate Care Facility in Chicago, Illinois

NPI 1588842470

St. Mary Of Providence is a Intellectual Disabilities Intermediate Care Facility based in Chicago, IL. St. Mary Of Providence practices in Chicago, IL. The NPI Number for St. Mary Of Providence is 1588842470 and holds a License No. 0033761 (Illinois).

The current practice location address for St. Mary Of Providence is 4200 N Austin Ave, Chicago, IL and can be reached out via phone at 773-545-8300 and via fax at 773-545-2984.

Location: 4200 N Austin Ave, Chicago, IL, 60634-1615

NPI Number

1588842470

Provider Name

St. Mary Of Providence

Credential

Provider Entity Type

Organization

Address

4200 N Austin Ave, Chicago, IL, 60634-1615

Phone Number

773-545-8300

Fax Number

773-545-2984

Provider Enumeration Date

02/04/2008

Last Update Date

03/09/2024

Identifier	Type	State	Issuer
14G191	05	IL

Address

4200 N Austin Ave

City

Chicago

State

Illinois

Zip

60634-1615

Phone Number

773-545-8300

Fax Number

773-545-2984

Address

4200 N Austin Ave

City

Chicago

State

Illinois

Zip

60634-1615

Phone Number

773-545-8300

Fax Number

773-545-2984

Type

Nursing & Custodial Care Facilities

Classification

Intermediate Care Facility, Mentally Retarded

Speciality

Taxonomy

315P00000X

License No.

0033761 (Illinois)

Definition

(1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals.

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