Provider Demographics
NPI:1922375658
Name:SAINTS MARY AND ELIZABETH MEDICAL CENTER
Entity Type:Organization
Organization Name:SAINTS MARY AND ELIZABETH MEDICAL CENTER
Other - Org Name:RESURRECTION BEHAVIORAL HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT, RESURRECTION BEHAVI
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:PERHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-338-3806
Mailing Address - Street 1:1127 N. OAKLEY--3RD FLOOR
Mailing Address - Street 2:NAZARETH FAMILY CENTER
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622
Mailing Address - Country:US
Mailing Address - Phone:312-770-2317
Mailing Address - Fax:312-770-2557
Practice Address - Street 1:1127 N. OAKLEY--3RD FLOOR
Practice Address - Street 2:NAZARETH FAMILY CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622
Practice Address - Country:US
Practice Address - Phone:312-770-2317
Practice Address - Fax:312-770-2557
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINTS MARY AND ELIZABETH MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2584261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)