Healthcare Provider Details

I. General information

NPI: 1336582279
Provider Name (Legal Business Name): JANASTON MANAGEMENT & DEVELOPMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 04/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4942 W DIVISION ST
CHICAGO IL
60651-3158
US

IV. Provider business mailing address

4942 W DIVISION
CHICAGO IL
60651
US

V. Phone/Fax

Practice location:
  • Phone: 773-261-0075
  • Fax:
Mailing address:
  • Phone: 773-261-0075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. LINDA RENEE WESLEY-JOSEPH
Title or Position: CEO, COUNSELOR
Credential: CADC, GERONTOLOGIST
Phone: 773-261-0075