MEDICARE: MARYVILLE ACADEMY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1003341058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARYVILLE ACADEMY

Provider Business Mailing Address
First Line	:	1658 W GRAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-6309
Country	:	US
Telephone Number	:	312-491-3530
Fax Number	:

Provider Business Practice Location Address
First Line	:	1658 W GRAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-6309
Country	:	US
Telephone Number	:	312-491-3530
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR OF COMMUNITY SERVICES
Name	:	FREDERICK SMITH
Credential	:
Telephone Number	:	847-390-3004

Provider Enumeration Date	:	04/27/2017
Last Update Date	:	06/11/2025

Similar Medicare Providers

1508174749 — MARYVILLE ACADEMY
Practice Location Address:

1658 W GRAND AVE
CHICAGO, IL
60622-6309

Practice Phone: 312-491-3500
Practice Fax:

1902353782 — MARYVILLE ACADEMY
Practice Location Address:

1658 W GRAND AVE
CHICAGO, IL
60622-6309

Practice Phone: 312-491-3530
Practice Fax:

1588474480 — GRAND GONAIVES
Practice Location Address:

2115 W 94TH ST
CHICAGO, IL
60643-6309

Practice Phone: 773-615-1638
Practice Fax:

1942343223 — OPTIMUM SIGHT INC.
Practice Location Address:

6309 N LINCOLN AVE
CHICAGO, IL
60659-1203

Practice Phone: 773-267-1814
Practice Fax: 773-267-5298

1073792867 — DR. ALEX MARSHALKOVICH O.D.
Practice Location Address:

6309 N LINCOLN AVE
CHICAGO, IL
60659-1203

Practice Phone: 773-267-1814
Practice Fax:

1508173535 — AC PERFORMANCE PRO SYS HEWITT HOME CARE-AC PERF PRO
Practice Location Address:

5135 S BLACKSTONE AVE APT 200
CHICAGO, IL
60615-6309

Practice Phone: 773-675-6381
Practice Fax:

Directions to “MARYVILLE ACADEMY ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.