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General NPI Number Information
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NPI Number | 1093993065
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Entity Type | Organization
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Legal Business Name | ANNIE B. JONES COMMUNITY SERVICES, INC
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Dates
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Enumeration Date | 02/01/2008
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Last Update Date | 03/19/2010
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Provider Practice Location Address
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Address Line | 1818 E 71ST ST
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City | CHICAGO
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State | IL
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Zip | 60649-2010
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Country | US
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Telephone | 773-667-2100
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Fax | 773-667-9578
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Provider Business Mailing Address
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Address Line | 1507 E 53RD ST PMB 336
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City | CHICAGO
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State | IL
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Zip | 60615-4509
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Country | US
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Telephone | 773-667-2100
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Fax | 773-667-6736
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Authorized Official
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Title or Position | FOUNDER/PRESIDENT & CEO
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Name | DR. VIVIAN ROSE JONES
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Credential | M.ED
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Telephone | 773-667-2100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | A88350001A
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License Number State | IL
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