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General NPI Number Information
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NPI Number | 1275863730
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Entity Type | Organization
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Legal Business Name | HIGH FIVE KIDS, INC.
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Dates
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Enumeration Date | 01/06/2010
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Last Update Date | 01/06/2010
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Provider Practice Location Address
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Address Line | 1327 W CORNELIA AVE
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City | CHICAGO
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State | IL
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Zip | 60657-1401
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Country | US
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Telephone | 414-303-8847
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Fax |
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Provider Business Mailing Address
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Address Line | 1327 W CORNELIA AVE
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City | CHICAGO
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State | IL
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Zip | 60657-1401
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Country | US
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Telephone | 414-303-8847
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Fax |
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Authorized Official
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Title or Position | OWNER/CONSULTANT
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Name | MS. MARY BALTHASAR
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Credential | M.ED.
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Telephone | 773-348-0238
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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