MEDICARE: HIGH FIVE KIDS, INC.

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1275863730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGH FIVE KIDS, INC.

Provider Business Mailing Address
First Line	:	1327 W CORNELIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-1401
Country	:	US
Telephone Number	:	414-303-8847
Fax Number	:

Provider Business Practice Location Address
First Line	:	1327 W CORNELIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-1401
Country	:	US
Telephone Number	:	414-303-8847
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CONSULTANT
Name	:	MS. MARY BALTHASAR
Credential	:	M.ED.
Telephone Number	:	773-348-0238

Provider Enumeration Date	:	01/06/2010
Last Update Date	:	01/06/2010

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