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General NPI Number Information
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NPI Number | 1356517544
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Entity Type | Organization
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Legal Business Name | MERCY HOSPITAL & MEDICAL CENTER DASA
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Dates
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Enumeration Date | 05/07/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2525 S MICHIGAN AVE B-522
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City | CHICAGO
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State | IL
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Zip | 60616-2333
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Country | US
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Telephone | 312-567-6691
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Fax | 312-567-6156
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Provider Business Mailing Address
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Address Line | 2525 S MICHIGAN AVE B-522
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City | CHICAGO
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State | IL
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Zip | 60616-2333
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Country | US
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Telephone | 312-567-6691
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Fax | 312-567-6156
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Authorized Official
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Title or Position | VP FINANCE CFO
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Name | THOMAS J GARVEY
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Credential |
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Telephone | 312-567-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 007
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License Number State | IL
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