Healthcare Provider Details

I. General information

NPI: 1336146729
Provider Name (Legal Business Name): ST MARYS HOSPITAL STREATOR HOSPITAL SISTERS OF THE 3RD ORDR ST FRANCIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SPRING ST
STREATOR IL
61364-3332
US

IV. Provider business mailing address

111 SPRING ST
STREATOR IL
61364-3332
US

V. Phone/Fax

Practice location:
  • Phone: 815-673-4516
  • Fax: 815-673-4542
Mailing address:
  • Phone: 815-673-4516
  • Fax: 815-673-4542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1001791
License Number StateIL

VIII. Authorized Official

Name: MARK S O'HALLA
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 815-673-2311