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General NPI Number Information
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NPI Number | 1376900571
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Entity Type | Organization
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Legal Business Name | UCP SEGUIN GREATER CHICAGO
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Dates
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Enumeration Date | 01/20/2016
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Last Update Date | 01/20/2016
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Provider Practice Location Address
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Address Line | 7550 W. 183RD
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City | TINLEY PARK
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State | IL
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Zip | 60477
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Country | US
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Telephone | 708-863-3803
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Fax |
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Provider Business Mailing Address
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Address Line | 3100 S. CENTRAL AVE.
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City | CICETO
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State | IL
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Zip | 60804
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Country | US
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Telephone | 708-863-3803
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Fax |
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Authorized Official
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Title or Position | CLINICAL SERVICES ADMINISTRATOR
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Name | DONNA ROBINSON
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Credential |
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Telephone | 708-863-3803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number |
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License Number State | IL
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