MEDICARE: LITTLE ANGELS ECE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1215387519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE ANGELS ECE

Provider Business Mailing Address
First Line	:	3613 W DEVON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-1207
Country	:	US
Telephone Number	:	773-478-5555
Fax Number	:	888-745-3166

Provider Business Practice Location Address
First Line	:	3613 W DEVON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-1207
Country	:	US
Telephone Number	:	773-478-5555
Fax Number	:	888-745-3166

Authorized Official
Title or Position	:	OPERATIONS
Name	:	S. V KATSIBAROS
Credential	:
Telephone Number	:	773-478-5555

Provider Enumeration Date	:	06/16/2016
Last Update Date	:	06/16/2016

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