Provider Demographics
NPI:1689738957
Name:LITTLE COMPANY OF MARY HOSPITAL INC
Entity Type:Organization
Organization Name:LITTLE COMPANY OF MARY HOSPITAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER BUSINESS OFFICE
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-229-5126
Mailing Address - Street 1:2800 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2701
Mailing Address - Country:US
Mailing Address - Phone:708-422-6200
Mailing Address - Fax:708-499-8510
Practice Address - Street 1:2800 W 95TH ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2701
Practice Address - Country:US
Practice Address - Phone:708-422-6200
Practice Address - Fax:708-499-8510
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LITTLE COMPANY OF MARY HOSPITAL AND HEALTH CARE CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-21
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1744976273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14S179Medicare ID - Type UnspecifiedPSYCH