Healthcare Provider Details

I. General information

NPI: 1437117520
Provider Name (Legal Business Name): JAMAL PLACE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 S CALIFORNIA AVE
CHICAGO IL
60608
US

IV. Provider business mailing address

1335 S CALIFORNIA AVENUE
CHICAGO IL
60608
US

V. Phone/Fax

Practice location:
  • Phone: 773-277-6631
  • Fax: 773-277-7049
Mailing address:
  • Phone: 773-277-6631
  • Fax: 773-277-7049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number267674
License Number StateIL

VIII. Authorized Official

Name: MS. ANN G DEUEL
Title or Position: EXECUTIVE DIRECTOR
Credential: MA
Phone: 773-277-6631