Healthcare Provider Details

I. General information

NPI: 1457802365
Provider Name (Legal Business Name): SAINT MARY SAINT ELIZABETH MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 N OAKLEY BLVD 3RD FL, NFC BUIDLING
CHICAGO IL
60622-3507
US

IV. Provider business mailing address

2233 W DIVISION ST 1127 N. OAKLEY, 3RD FL. NFC BLDG
CHICAGO IL
60622-8151
US

V. Phone/Fax

Practice location:
  • Phone: 312-770-2317
  • Fax: 312-770-2557
Mailing address:
  • Phone: 312-770-2317
  • Fax: 312-770-2557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateIL

VIII. Authorized Official

Name: FRANK PERHAM
Title or Position: VICE PRESIDENT
Credential: LCPC
Phone: 708-338-3806