MEDICARE: HUMAN RESOURCES DEVELOPMENT INSTITUTE- CHICAGO TEENS

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		IL

General Provider Information

NPI Number	:	1902084247
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUMAN RESOURCES DEVELOPMENT INSTITUTE- CHICAGO TEENS

Provider Business Mailing Address
First Line	:	222 S JEFFERSON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60661-5603
Country	:	US
Telephone Number	:	312-441-9009
Fax Number	:	312-441-9019

Provider Business Practice Location Address
First Line	:	2311 E 98TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-4842
Country	:	US
Telephone Number	:	773-933-5570
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MR. EFFIE G BARNER
Credential	:
Telephone Number	:	312-441-9009

Provider Enumeration Date	:	02/08/2008
Last Update Date	:	02/08/2008

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