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General NPI Number Information
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NPI Number | 1336146729
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Entity Type | Organization
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Legal Business Name | ST MARYS HOSPITAL STREATOR HOSPITAL SISTERS OF THE 3RD ORDR ST FRANCIS
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Dates
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Enumeration Date | 06/30/2005
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Last Update Date | 10/11/2012
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Provider Practice Location Address
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Address Line | 111 SPRING ST
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City | STREATOR
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State | IL
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Zip | 61364-3332
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Country | US
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Telephone | 815-673-4516
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Fax | 815-673-4542
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Provider Business Mailing Address
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Address Line | 111 SPRING ST
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City | STREATOR
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State | IL
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Zip | 61364-3332
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Country | US
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Telephone | 815-673-4516
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Fax | 815-673-4542
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT
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Name | MARK S O'HALLA
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Credential |
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Telephone | 815-673-2311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1001791
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License Number State | IL
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