Provider Demographics
NPI:1033219803
Name:MOUNT ST JOSEPH
Entity type:Organization
Organization Name:MOUNT ST JOSEPH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-438-5050
Mailing Address - Street 1:24955 N HIGHWAY 12
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047
Mailing Address - Country:US
Mailing Address - Phone:847-438-5050
Mailing Address - Fax:847-719-1060
Practice Address - Street 1:24955 N HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047
Practice Address - Country:US
Practice Address - Phone:847-438-5050
Practice Address - Fax:847-719-1060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0005520320600000X
315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001OtherIL DEPT OF PUBLIC AID
IL=========002OtherIL DEPT OF PUBLIC AID