Individual
MARIA GROSU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5115 CHURCH ST, SUITE 100, SKOKIE, IL 60077-1201
(847) 677-4933
(847) 679-3973
Mailing address
5115 CHURCH ST, SUITE 100, SKOKIE, IL 60077-1201
(847) 677-4933
(847) 679-3973
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
200000006C
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3000006
MCO PLAN
IL
01
—
7094638
BILLING AGENCY
IL
Enumeration date
04/04/2016
Last updated
04/04/2016
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