Organization
ST. MARY OF PROVIDENCE DEVELOPMENTAL TRAINING PROGRAM
Active
Parent organization
ST. MARY OF PROVIDENCE
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST. MARY OF PROVIDENCE
Authorized official
CHARLEEN M BADIOLA (DIRECTOR)
(773) 545-8300
Entity
Organization
Contact information
Practice address
4200 N AUSTIN AVE, CHICAGO, IL 60634-1615
(773) 545-8300
Mailing address
4200 N AUSTIN AVE, CHICAGO, IL 60634-1615
(773) 545-8300
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
36217748
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14G191
—
IL
Enumeration date
06/03/2016
Last updated
06/03/2016
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