Provider Demographics
NPI:1548623861
Name:GROSU, MARIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:GROSU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5115 CHURCH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1201
Mailing Address - Country:US
Mailing Address - Phone:847-677-4933
Mailing Address - Fax:847-679-3973
Practice Address - Street 1:5115 CHURCH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1201
Practice Address - Country:US
Practice Address - Phone:847-677-4933
Practice Address - Fax:847-679-3973
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL200000006C320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7094638OtherBILLING AGENCY
IL3000006OtherMCO PLAN