Provider Demographics
NPI:1437733979
Name:CTF ILLINOIS
Entity Type:Organization
Organization Name:CTF ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:AMBROSINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-429-1260
Mailing Address - Street 1:18230 ORLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-5688
Mailing Address - Country:US
Mailing Address - Phone:708-429-1260
Mailing Address - Fax:
Practice Address - Street 1:914 17TH ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-2917
Practice Address - Country:US
Practice Address - Phone:708-429-1260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)