Provider Demographics
NPI:1417707225
Name:ST MARY'S SERVICES
Entity Type:Organization
Organization Name:ST MARY'S SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MPPA
Authorized Official - Phone:847-504-6243
Mailing Address - Street 1:510 N PLUM GROVE RD
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-3522
Mailing Address - Country:US
Mailing Address - Phone:847-504-6243
Mailing Address - Fax:
Practice Address - Street 1:510 N PLUM GROVE RD
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-3522
Practice Address - Country:US
Practice Address - Phone:847-504-6243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST MARY'S SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251K00000XAgenciesPublic Health or Welfare