Organization
NINE FORTY CULLOM CORPORATION
Active
Other names
MADO HEALTHCARE - BUENA PARK
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETER J OBRIEN (PRESIDENT)
(312) 787-9400
Entity
Organization
Contact information
Practice address
940 W CULLOM AVE, CHICAGO, IL 60613
(773) 525-9000
(773) 525-8016
Mailing address
405 N WABASH AVE STE P2W, CHICAGO, IL 60611-3541
(312) 787-9400
(312) 787-9434
Taxonomy
Speciality
Code
Description
License number
State
310500000X
Mental Illness Intermediate Care Facility
Primary
0017178
IL
Other
Enumeration date
11/04/2005
Last updated
04/15/2019
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