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General NPI Number Information
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NPI Number | 1285879668
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Entity Type | Organization
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Legal Business Name | A&K CHILD GUIDANCE CENTER INC.
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Dates
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Enumeration Date | 12/12/2008
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Last Update Date | 12/12/2008
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Provider Practice Location Address
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Address Line | 641 S LOMBARD AVE
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City | LOMBARD
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State | IL
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Zip | 60148-3451
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Country | US
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Telephone | 630-337-2893
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Fax |
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Provider Business Mailing Address
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Address Line | 641 S LOMBARD AVE
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City | LOMBARD
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State | IL
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Zip | 60148-3451
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Country | US
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Telephone | 630-337-2893
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Fax |
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Authorized Official
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Title or Position | SHARE HOLDER
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Name | DR. MOHAMMED ALI
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Credential | M.D.,
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Telephone | 630-337-2893
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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 | 036119188
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License Number State | IL
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