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General NPI Number Information
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NPI Number | 1386334142
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Entity Type | Organization
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Legal Business Name | MOTHERLAND SHELTERED SERVICES INC
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Dates
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Enumeration Date | 05/15/2023
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Last Update Date | 05/15/2023
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Provider Practice Location Address
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Address Line | 14921 PERRY AVE
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-1044
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Country | US
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Telephone | 630-863-0722
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Fax |
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Provider Business Mailing Address
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Address Line | 2735 HASSERT BLVD, STE 135, #681 C/O AYODEJI ADEGOYE
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City | NAPERVILLE
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State | IL
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Zip | 60564
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Country | US
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Telephone | 630-863-0722
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | AYODEJI ADEGOYE
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Credential |
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Telephone | 630-863-0722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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