Provider Demographics
NPI:1336146729
Name:ST MARYS HOSPITAL STREATOR HOSPITAL SISTERS OF THE 3RD ORDR ST FRANCIS
Entity Type:Organization
Organization Name:ST MARYS HOSPITAL STREATOR HOSPITAL SISTERS OF THE 3RD ORDR ST FRANCIS
Other - Org Name:ST MARYS HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:O'HALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-673-2311
Mailing Address - Street 1:111 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:STREATOR
Mailing Address - State:IL
Mailing Address - Zip Code:61364-3332
Mailing Address - Country:US
Mailing Address - Phone:815-673-4516
Mailing Address - Fax:815-673-4542
Practice Address - Street 1:111 SPRING ST
Practice Address - Street 2:
Practice Address - City:STREATOR
Practice Address - State:IL
Practice Address - Zip Code:61364-3332
Practice Address - Country:US
Practice Address - Phone:815-673-4516
Practice Address - Fax:815-673-4542
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST MARYS HOSPITAL STREATOR HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-30
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1001791251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147173Medicare ID - Type Unspecified