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General NPI Number Information
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NPI Number | 1508041542
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Entity Type | Organization
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Legal Business Name | MOSAIC CHILDHOOD PROJECT, INC.
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Dates
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Enumeration Date | 01/09/2008
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Last Update Date | 01/09/2008
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Provider Practice Location Address
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Address Line | 1333 W NORTH SHORE AVE 3N
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City | CHICAGO
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State | IL
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Zip | 60626-4767
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Country | US
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Telephone | 773-575-6215
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Fax | 773-341-7376
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Provider Business Mailing Address
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Address Line | 1333 W NORTH SHORE AVE 3N
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City | CHICAGO
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State | IL
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Zip | 60626-4767
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Country | US
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Telephone | 773-575-6215
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Fax | 773-341-7376
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Authorized Official
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Title or Position | PRESIDENT
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Name | JESSICA L MCCARTHY
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Credential | MS CCC/SLP
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Telephone | 773-575-6215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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