Organization
MARYVILLE ACADEMY
Active
Other names
Maryville Scott Nolan
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
555 WILSON LN, DES PLAINES, IL 60016-4729
(847) 768-5461
(847) 768-5478
Mailing address
1150 N RIVER RD, DES PLAINES, IL 60016-1214
(847) 294-1899
(847) 294-2892
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
240521-04
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
240521-04
DCFS - RTC
IL
Enumeration date
07/04/2006
Last updated
07/08/2022
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