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General NPI Number Information
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NPI Number | 1235791112
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Entity Type | Organization
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Legal Business Name | ENRICHING CREATIVE MINDS EARLY INTERVENTION LLC
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Dates
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Enumeration Date | 07/01/2019
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Last Update Date | 07/01/2019
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Provider Practice Location Address
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Address Line | 557 S CANYON DR
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City | ROMEOVILLE
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State | IL
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Zip | 60446-4309
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Country | US
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Telephone | 708-257-2781
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Fax | 815-524-5718
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Provider Business Mailing Address
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Address Line | PO BOX 703
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City | PLAINFIELD
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State | IL
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Zip | 60544-0703
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Country | US
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Telephone | 708-257-2781
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Fax | 815-524-5718
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Authorized Official
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Title or Position | DEVELOPMENTAL THERAPIST
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Name | LORELLE BEAUGARD
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Credential |
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Telephone | 708-257-2781
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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