ST. MARY OF PROVIDENCE (NPI# 1588842470) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588842470 |
| Entity Type | Organization |
| Organization Name | ST. MARY OF PROVIDENCE |
| Other Organization Name | ROSE ANGELA HALL |
| Practice Address |
4200 N Austin Ave Chicago IL 60634-1615 |
| Practice Telephone | 7735458300 |
| Practice Fax Number | 7735452984 |
| Mailing Telephone | 7735458300 |
| Mailing Fax Number | 7735452984 |
| Enumeration Date | 2008-02-04 |
| Last Update Date | 2008-02-04 |
| Authorized Official Name | RITA M BUTLER (DIRECTOR) |
| Authorized Official Telephone | 7735458300 |
| Authorized Official Credential | R.N., NHA |
| Is Organization Subpart | Y |
| Parent Organization Name | ST. MARY OF PROVIDENCE |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | 0033761 | IL | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 14G191 | 05 |
| Other Name | Type Code |
|---|---|
| Rose Angela Hall | Doing Business As Name - Organization |
| Street Address |
4200 N AUSTIN AVE |
| City | CHICAGO |
| State | IL |
| Zip Code | 60634-1615 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609224328 | St. Mary of Providence Developmental Training Program | Day Training, Developmentally Disabled Services | 4200 N Austin Ave, Chicago, IL 60634-1615 | 2016-06-03 |
| 1417305897 | Providence Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4200 N Austin Ave, Chicago, IL 60634-1615 | 2016-05-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356987333 | Alejandra Carrera | Student in an Organized Health Care Education/Training Program | 6417 W Irving Park Rd., Chicago, IL 60634 | 2019-11-25 |
| 1861977456 | Virtue Counseling Center | Counselor | 2904 N Parkside, Chicago, IL 60634 | 2018-09-28 |
| 1770931255 | Dynamic Transport Solutions LLC | Non-emergency Medical Transport (VAN) | 6109 W. Barry, Chicago, IL 60634 | 2016-05-25 |
| 1104284710 | Ez Dental | Dental Laboratory | 5621 W.montrose Avenue, Chicago, IL 60634 | 2016-02-10 |
| 1285075432 | Chicago Medical Transportation | Non-emergency Medical Transport (VAN) | 3033 N. Nordica Ave., Chicago, IL 60634 | 2013-07-16 |
| 1083985725 | Maria C. Rodriguez | Lactation Consultant, Non-RN | 6216 W. School St., Chicago, IL 60634 | 2012-01-25 |
| 1295066827 | Angie Harris | Occupational Therapist | 3339 N. Octavia, Chicago, IL 60634 | 2010-01-21 |
| 1205169802 | Belmont Dental P.C. | Dentist | 5611 W. Belmont Ave., Chicago, IL 60634 | 2009-09-14 |
| 1568605178 | Henry Biskup | Radiologic Technologist | 3105 N. Austin Ave., Chicago, IL 60634 | 2009-04-13 |
| 1306086624 | Highland Park Cvs, L.L.C. | Durable Medical Equipment & Medical Supplies | 3615 N. Central Ave, Chicago, IL 60634 | 2009-02-26 |
| Find all providers in zip 60634 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871650655 | Progressive Housing, Inc. | Intermediate Care Facility, Mentally Retarded | 7270 S South Shore Dr, Chicago, IL 60649-2718 | 2007-01-02 |
| 1003864844 | Misericordia Home | Intermediate Care Facility, Mentally Retarded | 6300 N Ridge Ave, Chicago, IL 60660-1017 | 2006-05-04 |
| 1861849721 | Misericordia Home | Intermediate Care Facility, Mentally Retarded | 6300 N Ridge Ave, Chicago, IL 60660-1017 | 2016-05-20 |
| 1134576093 | Misericordia Home | Intermediate Care Facility, Mentally Retarded | 6300 N Ridge Ave, Chicago, IL 60660-1017 | 2016-05-20 |
| 1871940734 | Misericordia Home | Intermediate Care Facility, Mentally Retarded | 6300 N Ridge Ave, Chicago, IL 60660-1017 | 2016-05-20 |
| 1043667900 | Misericordia Home | Intermediate Care Facility, Mentally Retarded | 6300 N Ridge Ave, Chicago, IL 60660-1017 | 2016-05-20 |
| 1447610027 | Misericordia Home | Intermediate Care Facility, Mentally Retarded | 6300 N Ridge Ave, Chicago, IL 60660-1017 | 2016-02-25 |
| 1396049391 | Misericordia Home | Intermediate Care Facility, Mentally Retarded | 6300 N Ridge Ave, Chicago, IL 60660-1017 | 2011-01-05 |
| 1972806784 | Misericordia Home | Intermediate Care Facility, Mentally Retarded | 6300 N Ridge Ave, Chicago, IL 60660-1017 | 2010-12-16 |
| 1063715878 | Misericordia Home | Intermediate Care Facility, Mentally Retarded | 6300 N Ridge Ave, Chicago, IL 60660-1017 | 2010-12-16 |
| Find all providers in CHICAGO | ||||
Please comment or provide details below to improve the information on ST. MARY OF PROVIDENCE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.