1093993065 NPI number — ANNIE B. JONES COMMUNITY SERVICES, INC

Table of content: (NPI 1093993065)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093993065 NPI number — ANNIE B. JONES COMMUNITY SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANNIE B. JONES COMMUNITY SERVICES, INC
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:
6
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:
1093993065
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1507 E 53RD ST
Provider Second Line Business Mailing Address:
PMB 336
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60615-4509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-667-2100
Provider Business Mailing Address Fax Number:
773-667-6736

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1818 E 71ST 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:
60649-2010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-667-2100
Provider Business Practice Location Address Fax Number:
773-667-9578
Provider Enumeration Date:
02/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
VIVIAN
Authorized Official Middle Name:
ROSE
Authorized Official Title or Position:
FOUNDER/PRESIDENT & CEO
Authorized Official Telephone Number:
773-667-2100

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  A88350001A , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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