=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225346893
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 1ST STEPS TO SUCCESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2010
-----------------------------------------------------
Last Update Date | 09/16/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 209 CANDLEWICK RD
-----------------------------------------------------
City | WATERLOO
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50703-1303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-240-2119
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 909 WILLOW RD
-----------------------------------------------------
City | MATTESON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60443-1981
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-310-0600
-----------------------------------------------------
Fax | 708-620-5317
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING PARTNER
-----------------------------------------------------
Name | MS. CARLA BILLUPS CALDWELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 708-310-0600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 00725
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------