Healthcare Provider Details

I. General information

NPI: 1255576393
Provider Name (Legal Business Name): CHICAGOLAND EARLY INTERVENTION LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 12/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6006 159TH ST BLDG B
OAK FOREST IL
60452-2904
US

IV. Provider business mailing address

6006 159TH ST BLDG B
OAK FOREST IL
60452-2904
US

V. Phone/Fax

Practice location:
  • Phone: 708-535-0933
  • Fax: 708-614-9435
Mailing address:
  • Phone: 708-535-0933
  • Fax: 708-614-9435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. SADHNA NAVNI
Title or Position: VICE PRESIDENT
Credential: OTR/L
Phone: 708-535-0933