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Organization subpart
No

Provider details

NPI number
Authorized official
MS. MARY PAT O'BRIEN (ADMINISTRATOR)
(773) 273-4169
Entity
Organization

Contact information

Practice address
6300 N RIDGE AVE, CHICAGO, IL 60660-1017
(773) 973-6300
Mailing address
6300 N RIDGE AVE, CHICAGO, IL 60660-1017
(773) 973-6300

Taxonomy

Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
0032607
IL

Other

Enumeration date
06/28/2006
Last updated
08/22/2020
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