Organization
MARYVILLE ACADEMY
Active
Other names
Maryville Crisis Nursery
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY Z WOULFE (DIRECTOR OF BUSINESS DEVELOPMENT)
(847) 294-1910
Entity
Organization
Contact information
Practice address
6650 W IRVING PARK RD, CHICAGO, IL 60634-2435
(773) 205-3605
(773) 205-3639
Mailing address
6650 W IRVING PARK RD, CHICAGO, IL 60634-2435
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
08/02/2022
Last updated
05/08/2023
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