Organization
MARY-GRACE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DUROGBAYI A. OGUNBAMERU MSW (PRESIDENT)
(708) 841-3171
Entity
Organization
Contact information
Practice address
14446 UNIVERSITY AVE, DOLTON, IL 60419-1904
(708) 841-3171
Mailing address
14446 UNIVERSITY AVE, DOLTON, IL 60419-1904
(708) 841-3171
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251E00000X
Home Health Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
—
Other
Enumeration date
07/28/2010
Last updated
07/28/2010
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