MEDICARE: VICTOR C. NEUMANN ASSOCIATION

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	251B00000X	Case Management Agency
2	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	199100067C	IL
3	251C00000X	Developmentally Disabled Services Day Training Agency
4	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1336145853
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICTOR C. NEUMANN ASSOCIATION

Provider Business Mailing Address
First Line	:	5547 N RAVENSWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-1125
Country	:	US
Telephone Number	:	773-506-3201
Fax Number	:	773-769-1476

Provider Business Practice Location Address
First Line	:	5547 N RAVENSWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-1125
Country	:	US
Telephone Number	:	773-506-3201
Fax Number	:	773-769-1476

Authorized Official
Title or Position	:	CEO
Name	:	DR. PAUL SELDEN
Credential	:	PH.D.
Telephone Number	:	773-769-4313

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	12/29/2015

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