Healthcare Provider Details

I. General information

NPI: 1831829670
Provider Name (Legal Business Name): NAPA CENTER CHICAGO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 W HARRISON ST # 5409
CHICAGO IL
60699-3916
US

IV. Provider business mailing address

11840 S LA CIENEGA BLVD STE 118
HAWTHORNE CA
90250-3459
US

V. Phone/Fax

Practice location:
  • Phone: 424-269-3400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: BRYAN LASCALA
Title or Position: GENERAL MANAGER
Credential:
Phone: 424-269-3400