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General NPI Number Information
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NPI Number | 1477160620
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Entity Type | Organization
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Legal Business Name | SOLID GROUND FOUNDATION FOR BEHAVIORAL SERVICES
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Dates
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Enumeration Date | 09/30/2020
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Last Update Date | 09/30/2020
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Provider Practice Location Address
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Address Line | 2033 198TH STREET
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City | LYNWOOD
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State | IL
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Zip | 60411-6080
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Country | US
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Telephone | 708-969-4109
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Fax |
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Provider Business Mailing Address
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Address Line | 11940 S SPRINGFIELD AVE
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City | ALSIP
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State | IL
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Zip | 60803-1117
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Country | US
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Telephone | 708-480-2475
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | INONGE L. MASON
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Credential |
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Telephone | 708-969-4109
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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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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