Healthcare Provider Details

I. General information

NPI: 1578731501
Provider Name (Legal Business Name): YOUTH SERVICE PROJECT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3942 W NORTH AVE
CHICAGO IL
60647-4639
US

IV. Provider business mailing address

3942 W NORTH AVE
CHICAGO IL
60647-4639
US

V. Phone/Fax

Practice location:
  • Phone: 773-772-6270
  • Fax: 773-772-8755
Mailing address:
  • Phone: 773-772-6270
  • Fax: 773-772-8755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateIL

VIII. Authorized Official

Name: MS. GINA ZUNIGA-BALDWIN III
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 773-772-6270