1518099084 NPI number — A PLACE FOR CHILDREN

Table of content: (NPI 1518099084)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518099084 NPI number — A PLACE FOR CHILDREN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A PLACE FOR CHILDREN
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:
1518099084
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3041 W NORTH SHORE AVE
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:
60645-4127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-208-7097
Provider Business Mailing Address Fax Number:
775-269-9239

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2425 W PRATT BLVD
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:
60645-4665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-208-7097
Provider Business Practice Location Address Fax Number:
775-269-9239
Provider Enumeration Date:
03/11/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RUNIONS
Authorized Official First Name:
RALPH
Authorized Official Middle Name:
F
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
219-331-4990

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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