Organization
MOUNT ST JOSEPH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAE EWALD (RESIDENT BENEFITS)
(847) 438-5050
Entity
Organization
Contact information
Practice address
24955 N US HIGHWAY 12, LAKE ZURICH, IL 60047-8919
(847) 438-5050
(847) 438-6313
Mailing address
24955 N US HIGHWAY 12, LAKE ZURICH, IL 60047-8919
(847) 438-5050
(847) 438-6313
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
0005520
IL
Other
Enumeration date
01/17/2017
Last updated
05/14/2020
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