Healthcare Provider Details

I. General information

NPI: 1336630029
Provider Name (Legal Business Name): REASSEMBLE EDUCATION & TRAINING,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 E 79TH ST STE 15
CHICAGO IL
60619-3037
US

IV. Provider business mailing address

644 E 79TH ST STE 15
CHICAGO IL
60619-3037
US

V. Phone/Fax

Practice location:
  • Phone: 312-296-1069
  • Fax: 773-633-8910
Mailing address:
  • Phone: 312-296-1069
  • Fax: 773-633-8910

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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. CARMEN A MEEKINS
Title or Position: CEO
Credential:
Phone: 312-296-1069