institution
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. You can also correspond with St. Mary Of Providence through the mailing address at 4200 N AUSTIN AVE, CHICAGO, IL - 60634-1615 (mailing address contact number: 773-545-8300).

Location: 4200 N Austin Ave, Chicago, IL, 60634-1615
institution
Provider Profile Details
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
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Provider's Legacy Identifiers
Identifier Type State Issuer
14G191 05 IL
institution
Provider Business Practice Location Address Details
Address
4200 N Austin Ave
City
State
Zip
60634-1615
Phone Number
773-545-8300
Fax Number
773-545-2984
person
Provider Business Mailing Address Details
Address
4200 N Austin Ave
City
State
Zip
60634-1615
Phone Number
773-545-8300
Fax Number
773-545-2984
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Intermediate Care Facility, Mentally Retarded
Speciality
-
Taxonomy
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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