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General NPI Number Information
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NPI Number | 1033902887
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Entity Type | Organization
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Legal Business Name | SAMS PLACE 78 LLC
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Dates
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Enumeration Date | 05/26/2025
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Last Update Date | 05/26/2025
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Provider Practice Location Address
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Address Line | 3424 FIR ST # 1
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City | EAST CHICAGO
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State | IN
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Zip | 46312-2014
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Country | US
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Telephone | 773-971-0439
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Fax |
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Provider Business Mailing Address
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Address Line | 7951 CALUMET AVE # 1102
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City | MUNSTER
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State | IN
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Zip | 46321-1215
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Country | US
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Telephone | 773-971-0439
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SHAVONNE MORRISON
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Credential | MSW
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Telephone | 219-613-3478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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