Healthcare Provider Details

I. General information

NPI: 1487885323
Provider Name (Legal Business Name): ACHIEVE BEYOND INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 02/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 WEBER RD SUITE 1
CREST HILL IL
60403-0965
US

IV. Provider business mailing address

2250 WEBER RD SUITE 1
CREST HILL IL
60403-0965
US

V. Phone/Fax

Practice location:
  • Phone: 815-730-1818
  • Fax: 815-730-0808
Mailing address:
  • Phone: 815-730-1818
  • Fax: 815-730-0808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT PADRON
Title or Position: DIRECTOR
Credential:
Phone: 212-684-0099