Healthcare Provider Details

I. General information

NPI: 1851995039
Provider Name (Legal Business Name): A BEAUTIFUL MIND, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2020
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5113 S HARPER AVE STE 2C
CHICAGO IL
60615-4119
US

IV. Provider business mailing address

5113 S HARPER AVE # 2C
CHICAGO IL
60615-4119
US

V. Phone/Fax

Practice location:
  • Phone: 773-304-3699
  • Fax:
Mailing address:
  • Phone: 773-304-3699
  • Fax:

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: CHIQUITA LEE
Title or Position: CEO/FOUNDER
Credential:
Phone: 773-304-3699