Provider Demographics
NPI:1578765426
Name:STICKNEY PUBLIC HEALTH DISTRICT
Entity Type:Organization
Organization Name:STICKNEY PUBLIC HEALTH DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUNOW
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:708-424-9200
Mailing Address - Street 1:5635 STATE RD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-2051
Mailing Address - Country:US
Mailing Address - Phone:708-237-8918
Mailing Address - Fax:708-237-8997
Practice Address - Street 1:5635 STATE RD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-2051
Practice Address - Country:US
Practice Address - Phone:708-424-9200
Practice Address - Fax:708-499-5427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL624250Medicare PIN