Healthcare Provider Details

I. General information

NPI: 1770934838
Provider Name (Legal Business Name): VICTOR C NEUMANN ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5547 N RAVENSWOOD AVE 1ST FLOOR
CHICAGO IL
60640-1125
US

IV. Provider business mailing address

5547 N RAVENSWOOD AVE 1ST FLOOR
CHICAGO IL
60640-1125
US

V. Phone/Fax

Practice location:
  • Phone: 773-769-4313
  • Fax: 773-769-1476
Mailing address:
  • Phone: 773-769-4313
  • Fax: 773-769-1476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL SELDEN
Title or Position: PRESIDENT & CEO
Credential:
Phone: 773-506-3024