MEDICARE: GORDIES FOUNDATION

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	:	1538500632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GORDIES FOUNDATION

Provider Business Mailing Address
First Line	:	6430 S ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60636-2717
Country	:	US
Telephone Number	:	773-895-9008
Fax Number	:

Provider Business Practice Location Address
First Line	:	6430 S ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60636-2717
Country	:	US
Telephone Number	:	773-895-9008
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. AUDREY J WRIGHT
Credential	:
Telephone Number	:	773-895-9008

Provider Enumeration Date	:	07/17/2013
Last Update Date	:	07/17/2013

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Directions to “GORDIES FOUNDATION ” Practice Location

Language	Start Address	Practice Location

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