# DIVINE PROVIDENCE OUTPATIENT THERAPY SERVICES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245537976
- **Authorized official:** MR. ARNOLD DONATO (MBR)
- **Authorized official phone:** (773) 433-3320

## Contact information

- **Practice address:** 401 W LAKE ST, SUITE B-101 CONCORD PLACE, NORTHLAKE, IL 60164-2435
- **Practice address phone:** (773) 433-3320
- **Practice address fax:** (733) 433-3331
- **Mailing address:** 3550 W PETERSON AVE, STE 306, CHICAGO, IL 60659-3270
- **Mailing address phone:** (773) 433-3320
- **Mailing address fax:** (773) 433-3331

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0400X | Rehabilitation Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 02/15/2011
- **Last updated:** 02/15/2011