Provider Demographics
NPI:1215395496
Name:LORETTO HOSPITAL
Entity Type:Organization
Organization Name:LORETTO HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TESA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANEWISHKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-854-5000
Mailing Address - Street 1:645 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644-5059
Mailing Address - Country:US
Mailing Address - Phone:773-854-5097
Mailing Address - Fax:
Practice Address - Street 1:645 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-5059
Practice Address - Country:US
Practice Address - Phone:773-854-5066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-03
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit