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General NPI Number Information
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NPI Number | 1063811149
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Entity Type | Organization
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Legal Business Name | HORSEFEATHERS
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Dates
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Enumeration Date | 08/14/2014
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Last Update Date | 08/14/2014
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Provider Practice Location Address
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Address Line | 1181 RIVERWOODS RD
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City | LAKE FOREST
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State | IL
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Zip | 60045-3459
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Country | US
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Telephone | 847-234-2411
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Fax | 847-905-0737
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Provider Business Mailing Address
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Address Line | 1181 RIVERWOODS RD
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City | LAKE FOREST
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State | IL
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Zip | 60045-3459
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Country | US
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Telephone | 847-234-2411
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Fax | 847-905-0737
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. NICHOLAS EB COYNE
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Credential |
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Telephone | 847-234-2411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number | 056.006145
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License Number State | IL
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