Healthcare Provider Details

I. General information

NPI: 1740940741
Provider Name (Legal Business Name): BRAIN BOX LITERACY ACADEMY AND EDUCATIONAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2021
Last Update Date: 12/19/2021
Certification Date: 12/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9304 S ASHLAND AVE
CHICAGO IL
60620-5119
US

IV. Provider business mailing address

1510 KINROSS ST
FLOSSMOOR IL
60422-4314
US

V. Phone/Fax

Practice location:
  • Phone: 773-230-9682
  • Fax: 773-424-3000
Mailing address:
  • Phone: 773-230-9682
  • Fax: 773-424-3000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AYESHA ELAMIN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 773-230-9682