1245585074 NPI number — APPLIED BEHAVIORAL COACHING MOMS, INC.

Table of content: (NPI 1245585074)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245585074 NPI number — APPLIED BEHAVIORAL COACHING MOMS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APPLIED BEHAVIORAL COACHING MOMS, 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:
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:
1245585074
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4043 STATE ROUTE 59
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAPERVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60564
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-299-4909
Provider Business Mailing Address Fax Number:
630-420-8957

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4043 S ROUTE 59
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPERVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60564-5802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-299-4909
Provider Business Practice Location Address Fax Number:
630-420-8957
Provider Enumeration Date:
07/18/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BURKE
Authorized Official First Name:
DANA
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
SECRETARY/TREASURER
Authorized Official Telephone Number:
630-299-4909

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  1-12-11491 , 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)

  • Identifier: 1235302449 . This is a "PRIVATE INSURANCE" identifier . This identifiers is of the category "OTHER".