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General NPI Number Information
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NPI Number | 1194774703
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Entity Type | Organization
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Legal Business Name | HAWTHORNE DEVELOPMENTAL AGENCY
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1820 RIDGE RD STE 207
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City | HOMEWOOD
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State | IL
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Zip | 60430-1758
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Country | US
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Telephone | 708-218-1863
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Fax | 708-418-3913
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Provider Business Mailing Address
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Address Line | 7383 EMERSON CT
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City | SCHERERVILLE
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State | IN
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Zip | 46375-1781
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Country | US
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Telephone | 708-218-1863
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Fax | 708-418-3913
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. SONYA HAWTHORNE
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Credential | DT
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Telephone | 708-218-1863
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State | IL
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