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General NPI Number Information
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NPI Number | 1538536735
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Entity Type | Organization
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Legal Business Name | DEBORAH'S PLACE
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Dates
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Enumeration Date | 08/24/2015
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Last Update Date | 08/24/2015
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Provider Practice Location Address
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Address Line | 2822 W JACKSON BLVD
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City | CHICAGO
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State | IL
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Zip | 60612-3653
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Country | US
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Telephone | 773-722-5080
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Fax | 773-722-5081
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Provider Business Mailing Address
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Address Line | 2822 W JACKSON BLVD
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City | CHICAGO
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State | IL
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Zip | 60612-3653
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Country | US
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Telephone | 773-722-5080
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Fax | 773-722-5081
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Authorized Official
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Title or Position | CHIEF STRATEGY OFFICER
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Name | MS. KATHARINE C BOOTON WILSON
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Credential | LCSW
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Telephone | 773-638-6392
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 149.007559
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 149.011208
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 149.016615
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 149.015965
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 150.015350
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License Number State | IL
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Taxonomy #6
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 149.011208
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License Number State | IL
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Taxonomy #7
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 149.016615
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License Number State | IL
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Taxonomy #8
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 149.015965
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License Number State | IL
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Taxonomy #9
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 150.015350
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License Number State | IL
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Taxonomy #10
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 149.007559
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License Number State | IL
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