Provider Demographics
NPI:1427410554
Name:SINAI PSYCHIATRY AND BEHAVORIAL HEALTH - HOLY CROSS
Entity Type:Organization
Organization Name:SINAI PSYCHIATRY AND BEHAVORIAL HEALTH - HOLY CROSS
Other - Org Name:ST. CASIMIR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT/COO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:C
Authorized Official - Last Name:TEITELBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-257-5332
Mailing Address - Street 1:2653 W OGDEN AVE
Mailing Address - Street 2:2ND FL
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-1647
Mailing Address - Country:US
Mailing Address - Phone:773-257-5300
Mailing Address - Fax:773-257-5330
Practice Address - Street 1:2601 W MARQUETTE RD
Practice Address - Street 2:ST. CASMIR BUILDING
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-1817
Practice Address - Country:US
Practice Address - Phone:773-257-5300
Practice Address - Fax:773-257-5330
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNT SINAI COMMUNITY FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-28
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0001644261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1639470867Medicaid
IL1932496114Medicaid
IL1629472451Medicaid
IL1750678934Medicaid