Organization
ST. MARY OF PROVIDENCE
Active
Parent organization
ST. MARY OF PROVIDENCE
Other names
Rose Angela Hall
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST. MARY OF PROVIDENCE
Authorized official
RITA M BUTLER R.N., NHA (DIRECTOR)
(773) 545-8300
Entity
Organization
Contact information
Practice address
4200 N AUSTIN AVE, CHICAGO, IL 60634-1615
(773) 545-8300
(773) 545-2984
Mailing address
4200 N AUSTIN AVE, CHICAGO, IL 60634-1615
(773) 545-8300
(773) 545-2984
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
0033761
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14G191
—
IL
Enumeration date
02/04/2008
Last updated
02/04/2008
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