Healthcare Provider Details

I. General information

NPI: 1831687011
Provider Name (Legal Business Name): BUILDING BLOCKS GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 ELM ST
PARK RIDGE IL
60068-3368
US

IV. Provider business mailing address

1208 ELM ST
PARK RIDGE IL
60068-3368
US

V. Phone/Fax

Practice location:
  • Phone: 224-592-5862
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name: IRENE DI MINERVINO
Title or Position: OWNER
Credential:
Phone: 224-592-5862