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General NPI Number Information
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NPI Number | 1205283850
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Entity Type | Organization
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Legal Business Name | EL VALOR CORPORATION
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Dates
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Enumeration Date | 05/24/2016
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Last Update Date | 05/24/2016
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Provider Practice Location Address
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Address Line | 1850 W 21ST ST
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City | CHICAGO
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State | IL
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Zip | 60608-2715
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Country | US
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Telephone | 312-492-5948
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Fax | 312-666-0831
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Provider Business Mailing Address
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Address Line | 1850 W 21ST ST
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City | CHICAGO
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State | IL
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Zip | 60608-2715
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Country | US
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Telephone | 312-492-5948
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Fax | 312-666-0831
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Authorized Official
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Title or Position | DIRECTOR OF FISCAL OPERATIONS
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Name | MR. JAMES BRUCE O'BRIEN
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Credential |
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Telephone | 312-492-5948
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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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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 199100061C
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License Number State | IL
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