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General NPI Number Information
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NPI Number | 1043004344
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Entity Type | Organization
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Legal Business Name | GRANNY'S CENTER
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Dates
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Enumeration Date | 04/09/2025
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 2338 E 99TH ST
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City | CHICAGO
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State | IL
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Zip | 60617-5228
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Country | US
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Telephone | 773-841-4321
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Fax |
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Provider Business Mailing Address
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Address Line | 730 W STRIEFF LN
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City | GLENWOOD
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State | IL
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Zip | 60425-1314
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Country | US
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Telephone | 773-841-4321
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR/CEO
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Name | DR. ABISOLA BAKARE
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Credential |
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Telephone | 773-841-4321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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