=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215372123
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YMCA OF METROPOLITAN CHICAGO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2013
-----------------------------------------------------
Last Update Date | 05/06/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 801 N DEARBORN ST
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60610-3316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-932-1200
-----------------------------------------------------
Fax | 312-932-1318
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 801 N DEARBORN ST
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60610-3316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-932-1200
-----------------------------------------------------
Fax | 312-932-1318
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/PRESIDENT
-----------------------------------------------------
Name | MR. RICHARD MALONE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 312-932-1200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------