1477850550 NPI number — INNOCENT CHILDREN FOUNDATION

Table of content: MS. SHARLEAN V GRAY-ADONIS COTA (NPI 1487058236)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477850550 NPI number — INNOCENT CHILDREN FOUNDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INNOCENT CHILDREN FOUNDATION
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:
Provider Other Organization Name Type Code:
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:
1477850550
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
836 S. ARLINGTON HEIGHTS RD
Provider Second Line Business Mailing Address:
195
Provider Business Mailing Address City Name:
ELK GROVE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
836 S ARLINGTON HEIGHTS RD
Provider Second Line Business Practice Location Address:
195
Provider Business Practice Location Address City Name:
ELK GROVE VLG
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60007-3667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-545-2211
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/25/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PARISI
Authorized Official First Name:
AMANDA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
312-545-2211

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 305S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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