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General NPI Number Information
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NPI Number | 1497543904
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Entity Type | Organization
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Legal Business Name | CHICAGOLAND THERAPLAY LLC
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Dates
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Enumeration Date | 04/26/2025
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Last Update Date | 04/26/2025
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Provider Practice Location Address
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Address Line | 4433 N FORESTVIEW AVE
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City | CHICAGO
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State | IL
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Zip | 60656-4128
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Country | US
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Telephone | 312-973-2993
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Fax |
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Provider Business Mailing Address
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Address Line | 4433 N FORESTVIEW AVE
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City | CHICAGO
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State | IL
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Zip | 60656-4128
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Country | US
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Telephone | 312-973-2993
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | YVETTE JURKOWSKI
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Credential |
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Telephone | 312-973-2993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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