=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043685688
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW HORIZON CENTER FOR THE DEVELOPMENTALLY DISABLED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2015
-----------------------------------------------------
Last Update Date | 12/08/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6737 W FOREST PRESERVE AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60634-1470
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-286-6226
-----------------------------------------------------
Fax | 773-286-7674
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6737 W FOREST PRESERVE AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60634-1470
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-286-6226
-----------------------------------------------------
Fax | 773-286-7674
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING DIRECTOR
-----------------------------------------------------
Name | MRS. PATRICIA PALMER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 773-286-6226
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------