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General NPI Number Information
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NPI Number | 1093018830
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Entity Type | Organization
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Legal Business Name | MOORE PROFESSIONAL CHILDCARE AND LEARNING CENTER
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Dates
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Enumeration Date | 12/17/2010
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Last Update Date | 06/25/2012
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Provider Practice Location Address
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Address Line | 3032 140TH PL
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City | BLUE ISLAND
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State | IL
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Zip | 60406-3357
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Country | US
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Telephone | 877-232-7242
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Fax | 877-232-7242
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Provider Business Mailing Address
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Address Line | 3032 140TH PL
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City | BLUE ISLAND
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State | IL
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Zip | 60406-3357
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Country | US
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Telephone | 877-232-7242
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Fax | 877-232-7242
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MISS SHAWNTINA MOORE
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Credential |
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Telephone | 877-232-7242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 056.008266
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License Number State | IL
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