Organization
DIVINE PROVIDENCE OUTPATIENT THERAPY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ARNOLD DONATO (MBR)
(773) 433-3320
Entity
Organization
Contact information
Practice address
401 W LAKE ST, SUITE B-101 CONCORD PLACE, NORTHLAKE, IL 60164-2435
(773) 433-3320
(733) 433-3331
Mailing address
3550 W PETERSON AVE, STE 306, CHICAGO, IL 60659-3270
(773) 433-3320
(773) 433-3331
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
02/15/2011
Last updated
02/15/2011
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