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General NPI Number Information
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NPI Number | 1578720041
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Entity Type | Organization
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Legal Business Name | MARYVILLE ACADEMY
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Dates
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Enumeration Date | 05/21/2008
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Last Update Date | 07/08/2022
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Provider Practice Location Address
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Address Line | 6650 W IRVING PARK RD
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City | CHICAGO
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State | IL
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Zip | 60634-2435
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Country | US
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Telephone | 773-205-3613
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Fax | 773-205-3630
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Provider Business Mailing Address
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Address Line | 1150 N RIVER RD
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City | DES PLAINES
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State | IL
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Zip | 60016-1214
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Country | US
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Telephone | 847-294-1999
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Fax | 847-294-2892
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Authorized Official
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Title or Position | DIRECTOR OF BUSINESS DEVELOPMENT
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Name | NANCY Z WOULFE
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Credential |
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Telephone | 847-294-1910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282E00000X
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Taxonomy Name | Long Term Care Hospital
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License Number |
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License Number State | IL
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