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General NPI Number Information
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NPI Number | 1295195295
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Entity Type | Organization
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Legal Business Name | ST. COLETTA'S OF ILLINOIS, INC.
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Dates
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Enumeration Date | 03/03/2016
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Last Update Date | 03/31/2022
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Provider Practice Location Address
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Address Line | 18350 CROSSING DR
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City | TINLEY PARK
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State | IL
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Zip | 60487-6294
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Country | US
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Telephone | 708-342-5200
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Fax |
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Provider Business Mailing Address
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Address Line | 18350 CROSSING DR
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City | TINLEY PARK
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State | IL
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Zip | 60487-6294
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Country | US
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Telephone | 708-342-5200
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Fax | 708-342-2579
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Authorized Official
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Title or Position | VICE PRESIDENT OF FINANCE & OPERATI
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Name | MRS. ANNETTE SKAFGAARD
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Credential |
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Telephone | 708-342-5253
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 199100115C
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 199100115C
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License Number State | IL
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