Provider Demographics
NPI:1477690873
Name:ST. BERNARD HOSPITAL
Entity Type:Organization
Organization Name:ST. BERNARD HOSPITAL
Other - Org Name:ST. BERNARD HOSPITAL PSYCH DPU
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:ALTON
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:773-962-4073
Mailing Address - Street 1:326 W 64TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621-3114
Mailing Address - Country:US
Mailing Address - Phone:773-962-4100
Mailing Address - Fax:773-962-9276
Practice Address - Street 1:326 W 64TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-3114
Practice Address - Country:US
Practice Address - Phone:773-962-4100
Practice Address - Fax:773-962-9276
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. BERNARD HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-01
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0002303273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid