St. Mary of Providence Developmental Training Program

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

License

36217748 Issued in IL

Legal business name

ST. MARY OF PROVIDENCE DEVELOPMENTAL TRAINING PROGRAM

Practice address

4200 N Austin Ave
Chicago, IL 60634-1615

Phone

(773) 545-8300

NPI assigned

Jun 3, 2016

Organization subpart

Yes

Parent organization

ST. MARY OF PROVIDENCEAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Charleen M Badiola

Title

Director

Phone

(773) 545-8300

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

St Mary of Providence3 organizations share this tax ID, including this one

Part of

St Mary of Providence

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Providence Center

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Chicago, IL
  • NPI 1417305897
  NPD tax ID
• St. Mary of Providence

  • Intellectual Disabilities Intermediate Care Facility
  • Chicago, IL
  • NPI 1588842470
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1464912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464912000000",
    "number": "1609224328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 N AUSTIN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606341615",
            "telephone_number": "773-545-8300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 N AUSTIN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606341615",
            "telephone_number": "773-545-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MARY OF PROVIDENCE DEVELOPMENTAL TRAINING PROGRAM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. MARY OF PROVIDENCE",
        "enumeration_date": "2016-06-03",
        "last_updated": "2016-06-03",
        "status": "A",
        "authorized_official_last_name": "BADIOLA",
        "authorized_official_first_name": "CHARLEEN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "773-545-8300"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "IL",
            "license": "36217748",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14G191",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• St. Jude Medical Center S.C.
• Rebecca L St. Louis, DPM
• Venezah St. Louis, LCSW
• St. Mary of Nazareth Hospital
• St. Mary of Providence
• St. Mary Therapy Services
• St. Pauls Corporation
• Anne Patrice St. Peter, PT, DPT
• Rachael Michelle St. Peter I, DPM
• Aimee M St. Pierre, APN, PMHNP-BC

• Developmentally Disabled Services Day Training Agency in Chicago, IL
• Providers in Chicago, IL by specialty
• Developmentally Disabled Services Day Training Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.