Healthcare Provider Details

I. General information

NPI: 1134654890
Provider Name (Legal Business Name): HENRY BOOTH HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 05/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2907 S. WABASH
CHICAGO IL
60616
US

IV. Provider business mailing address

2907 S WABASH AVE
CHICAGO IL
60616-3389
US

V. Phone/Fax

Practice location:
  • Phone: 312-949-3600
  • Fax: 312-225-6324
Mailing address:
  • Phone: 312-949-3600
  • Fax: 312-225-6324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: SCOTT PERKINS
Title or Position: CEO
Credential:
Phone: 312-949-3609