1093954075 NPI number — SGA YOUTH & FAMILY

Table of content: (NPI 1093954075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093954075 NPI number — SGA YOUTH & FAMILY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SGA YOUTH & FAMILY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SCHOLARSHIP AND GUIDANCE ASSOCIATION
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093954075
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3152 W. 47TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-321-9019
Provider Business Mailing Address Fax Number:
773-475-7454

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3152 W 47TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-321-9019
Provider Business Practice Location Address Fax Number:
773-475-7454
Provider Enumeration Date:
02/13/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ZHANG
Authorized Official First Name:
MARINA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
312-447-4334

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com