Provider Demographics
NPI:1457802365
Name:SAINT MARY SAINT ELIZABETH MEDICAL CENTER
Entity Type:Organization
Organization Name:SAINT MARY SAINT ELIZABETH MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:PERHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:708-338-3806
Mailing Address - Street 1:2233 W DIVISION ST
Mailing Address - Street 2:1127 N. OAKLEY, 3RD FL. NFC BLDG
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-8151
Mailing Address - Country:US
Mailing Address - Phone:312-770-2317
Mailing Address - Fax:312-770-2557
Practice Address - Street 1:1127 N OAKLEY BLVD
Practice Address - Street 2:3RD FL, NFC BUIDLING
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-3507
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:PRESENCE CHICAGO HOSP. NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)