Healthcare Provider Details

I. General information

NPI: 1790710010
Provider Name (Legal Business Name): THE CHILDREN'S PLACE HOME HEALTH ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3059 W. AUGUSTA
CHICAGO IL
60622
US

IV. Provider business mailing address

3059 W. AUGUSTA
CHICAGO IL
60622
US

V. Phone/Fax

Practice location:
  • Phone: 773-826-1230
  • Fax: 773-826-0705
Mailing address:
  • Phone: 773-826-1230
  • Fax: 773-826-0705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number1009372
License Number StateIL

VIII. Authorized Official

Name: MRS. CATHY KRIEGER
Title or Position: PRESIDENT & CEO
Credential:
Phone: 312-660-3021