Provider Demographics
NPI:1154509289
Name:ST. COLETTA'S OF ILLINOIS, INC.
Entity Type:Organization
Organization Name:ST. COLETTA'S OF ILLINOIS, INC.
Other - Org Name:COUNTRY CLUB TERRACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SKAFGAARD
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:708-342-5253
Mailing Address - Street 1:18350 CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-6294
Mailing Address - Country:US
Mailing Address - Phone:708-342-5200
Mailing Address - Fax:708-429-7021
Practice Address - Street 1:4900 183RD ST
Practice Address - Street 2:
Practice Address - City:COUNTRY CLUB HILLS
Practice Address - State:IL
Practice Address - Zip Code:60478-4568
Practice Address - Country:US
Practice Address - Phone:708-647-0752
Practice Address - Fax:708-342-2579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)