Healthcare Provider Details

I. General information

NPI: 1295781334
Provider Name (Legal Business Name): LITTLE COMPANY OF MARY AFFILIATED SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5660 W 95TH ST SUITE 1
OAK LAWN IL
60453-2380
US

IV. Provider business mailing address

5660 W 95TH ST SUITE 1
OAK LAWN IL
60453-2380
US

V. Phone/Fax

Practice location:
  • Phone: 708-499-2273
  • Fax: 708-857-4435
Mailing address:
  • Phone: 708-499-2273
  • Fax: 708-857-4435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. CAROL A HEENAN
Title or Position: DIRECTOR, PROFESSIONAL SERVICES
Credential:
Phone: 708-229-5171