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General NPI Number Information
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NPI Number | 1134654890
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Entity Type | Organization
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Legal Business Name | HENRY BOOTH HOUSE
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Dates
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Enumeration Date | 05/01/2017
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Last Update Date | 05/01/2017
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Provider Practice Location Address
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Address Line | 2907 S. WABASH
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City | CHICAGO
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State | IL
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Zip | 60616
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Country | US
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Telephone | 312-949-3600
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Fax | 312-225-6324
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Provider Business Mailing Address
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Address Line | 2907 S WABASH AVE
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City | CHICAGO
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State | IL
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Zip | 60616-3389
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Country | US
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Telephone | 312-949-3600
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Fax | 312-225-6324
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Authorized Official
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Title or Position | CEO
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Name | SCOTT PERKINS
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Credential |
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Telephone | 312-949-3609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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