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General NPI Number Information
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NPI Number | 1407268691
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Entity Type | Organization
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Legal Business Name | BOTTLES TO SOON
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Dates
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Enumeration Date | 05/22/2014
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Last Update Date | 05/22/2014
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Provider Practice Location Address
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Address Line | 9731 S INGLESIDE AVE
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City | CHICAGO
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State | IL
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Zip | 60628-1517
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Country | US
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Telephone | 773-683-8987
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Fax |
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Provider Business Mailing Address
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Address Line | 9731 S INGLESIDE AVE
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City | CHICAGO
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State | IL
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Zip | 60628-1517
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Country | US
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Telephone | 773-683-8987
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Fax |
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Authorized Official
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Title or Position | REGISTER NURSE
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Name | MARA DENISE WILSON
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Credential |
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Telephone | 773-683-8987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3140N1450X
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Taxonomy Name | Pediatric Skilled Nursing Facility
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License Number | 041380212
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License Number State | IL
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