Healthcare Provider Details
I. General information
NPI: 1225246515
Provider Name (Legal Business Name): VICTOR C. NEUMANN ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 05/18/2007
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
4828 W CORNELIA AVE
CHICAGO IL
60641-3541
US
IV. Provider business mailing address
5547 N RAVENSWOOD AVE
CHICAGO IL
60640-1125
US
V. Phone/Fax
- Phone: 773-676-2123
- Fax:
- Phone: 773-506-3201
- Fax: 773-769-1476
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 251B00000X |
| Taxonomy | Case Management Agency |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 320800000X |
| Taxonomy | Mental Illness Community Based Residential Treatment Facility |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 251S00000X |
| Taxonomy | Community/Behavioral Health Agency |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
PAUL
SELDEN
Title or Position: CEO
Credential: PH.D.
Phone: 773-769-4313