Healthcare Provider Details

I. General information

NPI: 1972567709
Provider Name (Legal Business Name): JUVENILE PROTECTIVE ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 N HALSTED ST
CHICAGO IL
60614-5501
US

IV. Provider business mailing address

1333 N KINGSBURY ST SUITE 306
CHICAGO IL
60622-2687
US

V. Phone/Fax

Practice location:
  • Phone: 312-440-1203
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RICHARD CALICA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 312-698-6940