=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265812044
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALL SAINTS CENTER INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2015
-----------------------------------------------------
Last Update Date | 06/05/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1329 ROSEMARY DR
-----------------------------------------------------
City | BOLINGBROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60490-4940
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-392-2088
-----------------------------------------------------
Fax | 708-233-9058
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1329 ROSEMARY DR
-----------------------------------------------------
City | BOLINGBROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60490-4940
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-392-2088
-----------------------------------------------------
Fax | 708-233-9058
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | GEOFFREY UJU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 773-392-2088
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251V00000X
-----------------------------------------------------
Taxonomy Name | Voluntary or Charitable Agency
-----------------------------------------------------
License Number | 336055458
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------