ST. MARY OF PROVIDENCE NPI 1588842470

NPI Information

  • NPI: 1588842470
  • Provider Name: ST. MARY OF PROVIDENCE
  • Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
  • Entity Type: Organization
  • Doing Business As: ROSE ANGELA HALL
  • CLIA Number: 14D1050388
  • Address: 4200 N AUSTIN AVE
    CHICAGO, IL
    ZIP 60634
  • Phone: (773) 545-8300

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NPI Details

ST. MARY OF PROVIDENCE is an intermediate care facility mentally retarded in Chicago, IL. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. ST. MARY OF PROVIDENCE NPI is 1588842470. The provider is registered as an organization entity type.
The provider Is Doing Business As Rose Angela Hall.

The provider's business location address is:

4200 N AUSTIN AVE
CHICAGO, IL
ZIP 60634-615
Phone: (773) 545-8300
Fax: (773) 545-2984

The provider's authorized official is Rita M Butler .
The authorized official title is Director and has the following contact phone number (773) 545-8300.

The CLIA number assigned to this NPI record is 14D1050388 - intermediate care facility for mentally retarded with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/4/2008 and was last updated on 2/4/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1315P00000XIntermediate Care Facility, Intellectual Disabilities0033761ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
114G191MEDICAIDILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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