COUNTRY CLUB TERRACE - NPI 1154509289 - Intermediate Care Facility, Intellectual Disabilities in Country Club Hills, IL

Q: What is St. Coletta's Of Illinois, Inc.'s NPI number?

The NPI number for St. Coletta's Of Illinois, Inc. is 1154509289. It was assigned to this organization in the NPPES registry on January 31, 2008. The provider is doing business as Country Club Terrace.

Q: What is St. Coletta's Of Illinois, Inc.'s specialty?

The primary specialty registered for this NPI is Intermediate Care Facility, Intellectual Disabilities with taxonomy code 315P00000X.

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About Country Club Terrace NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

COUNTRY CLUB TERRACE (NPI 1154509289) is a healthcare organization registered as an intermediate care facility, intellectual disabilities in Country Club Hills, Illinois and active in the NPI registry since January 2008. The organization holds 2 active CLIA laboratory certificates and lists Annette Skafgaard, Director Of Finance, as its authorized official.

NPPES Registry Identity

NPI1154509289

Entity TypeOrganization

Primary Taxonomy315P00000X

Legal Business NameST. COLETTA'S OF ILLINOIS, INC.

Location Address4900 183RD STCountry Club Hills, IL 60478-4568

Mailing Address18350 Crossing DrTinley Park, IL 60487-6294 · (708) 342-5200 · Fax (708) 429-7021

Phone(708) 647-0752

Fax(708) 342-2579

Organization SubpartNo

Authorized OfficialAnnette SkafgaardDirector Of Finance · (708) 342-5253

Enumeration DateJanuary 31, 2008

Last NPPES UpdateMarch 31, 2022

NPPES CertifiedMarch 31, 2022

✔ NPI 1154509289 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyIntermediate Care Facility, Intellectual DisabilitiesNursing & Custodial Care Facilities

Taxonomy Code315P00000X

Definition

An intermediate care facility providing services for individuals with intellectual disabilities.

Also ListedClinic/Center · Mental Health (Including Community Mental Health Center)Taxonomy 261QM0801X

4900 183RD ST, Country Club Hills, IL 60478

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Other Names 1

Doing Business AsCountry Club Terrace

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 14D2213572

St Colletas Of Illinois · Tinley Park, IL

Active · expires Feb 14, 2027

CLIA Number14D2213572

Laboratory TypeIntermediate Care Facility For Mentally Retarded

Certificate Effective DateFebruary 15, 2025

Certificate Expiration DateFebruary 14, 2027

Laboratory DirectorKaren Gall

Laboratory Phone(708) 342-5200

Laboratory LocationSt Colletas Of Illinois18350 Crossing Drive, Tinley Park, IL 60487

CLIA data matches this NPI record on: Address Phone

This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 14D1040101

Country Club Terrace · Country Club Hills, IL

Active · expires Apr 28, 2027

CLIA Number14D1040101

Laboratory TypeIntermediate Care Facility For Mentally Retarded

Certificate Effective DateApril 29, 2025

Certificate Expiration DateApril 28, 2027

Laboratory DirectorSandy A. Wanoskey

Laboratory Phone(708) 647-0752

Laboratory LocationCountry Club Terrace4900 W 183rd Street, Country Club Hills, IL 60478

CLIA data matches this NPI record on: Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is St. Coletta's Of Illinois, Inc.'s NPI number?

The NPI number for St. Coletta's Of Illinois, Inc. is 1154509289. It was assigned to this organization in the NPPES registry on January 31, 2008. The provider is doing business as Country Club Terrace.

Where is St. Coletta's Of Illinois, Inc. located?

St. Coletta's Of Illinois, Inc. is located at 4900 183rd St, Country Club Hills, IL 60478. The listed phone number is (708) 647-0752.

What is St. Coletta's Of Illinois, Inc.'s specialty?

The primary specialty registered for this NPI is Intermediate Care Facility, Intellectual Disabilities with taxonomy code 315P00000X.

Does St. Coletta's Of Illinois, Inc. hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for St. Coletta's Of Illinois, Inc. was last updated on March 31, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.