Provider Demographics
NPI:1518941541
Name:SALT CREEK THERAPY CENTER
Entity Type:Organization
Organization Name:SALT CREEK THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INS COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLAZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-448-8470
Mailing Address - Street 1:7300 W COLLEGE DR
Mailing Address - Street 2:STE 101
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463
Mailing Address - Country:US
Mailing Address - Phone:708-448-8470
Mailing Address - Fax:708-448-9651
Practice Address - Street 1:7 SALT CREEK LN
Practice Address - Street 2:STE 206
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60821
Practice Address - Country:US
Practice Address - Phone:630-850-2120
Practice Address - Fax:630-850-2123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL361083442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H81209Medicare UPIN
IL199413Medicare ID - Type Unspecified