Healthcare Provider Details

I. General information

NPI: 1922375658
Provider Name (Legal Business Name): SAINTS MARY AND ELIZABETH MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2011
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 N. OAKLEY--3RD FLOOR NAZARETH FAMILY CENTER
CHICAGO IL
60622
US

IV. Provider business mailing address

1127 N. OAKLEY--3RD FLOOR NAZARETH FAMILY CENTER
CHICAGO IL
60622
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 Number2584
License Number StateIL

VIII. Authorized Official

Name: MR. FRANK PERHAM
Title or Position: VICE PRESIDENT, RESURRECTION BEHAVI
Credential:
Phone: 708-338-3806