Healthcare Provider Details

I. General information

NPI: 1578720041
Provider Name (Legal Business Name): MARYVILLE ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6650 W IRVING PARK RD
CHICAGO IL
60634-2435
US

IV. Provider business mailing address

6650 W IRVING PARK RD
CHICAGO IL
60634-2435
US

V. Phone/Fax

Practice location:
  • Phone: 773-205-3613
  • Fax: 773-205-3630
Mailing address:
  • Phone: 847-294-1999
  • Fax: 847-294-2892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number StateIL

VIII. Authorized Official

Name: NANCY Z WOULFE
Title or Position: DIRECTOR OF BUSINESS DEVELOPMENT
Credential:
Phone: 847-294-1910