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General NPI Number Information
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NPI Number | 1386094480
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Entity Type | Organization
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Legal Business Name | MISERICORDIA HOME
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Dates
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Enumeration Date | 06/20/2016
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Last Update Date | 06/20/2016
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Provider Practice Location Address
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Address Line | 6300 N RIDGE AVE
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City | CHICAGO
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State | IL
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Zip | 60660-1017
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Country | US
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Telephone | 773-273-4191
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Fax |
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Provider Business Mailing Address
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Address Line | 6300 N RIDGE AVE
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City | CHICAGO
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State | IL
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Zip | 60660-1017
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CONTROLLER
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Name | STEVE SCHUETH
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Credential |
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Telephone | 773-273-4191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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License Number State | IL
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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 | 2000594
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License Number State | IL
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Taxonomy #3
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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 | 2000644
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License Number State | IL
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Taxonomy #4
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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 | 199600013C
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License Number State | IL
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Taxonomy #5
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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 | 2000602
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License Number State | IL
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