Basic Information
| Provider Information | |||||||||
| NPI: | 1215395496 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LORETTO HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 645 S CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606445059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7738545066 | ||||||||
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| Practice Location | |||||||||
| Address1: | 645 S CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606445059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7738545066 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2016 | ||||||||
| LastUpdateDate: | 01/24/2019 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | CATHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF PFS | ||||||||
| AuthorizedOfficialTelephone: | 7738545066 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.