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General NPI Number Information
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NPI Number | 1548623861
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Entity Type | Individual
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Provider Name | MARIA GROSU
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Gender | Female
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Dates
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Enumeration Date | 04/04/2016
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Last Update Date | 04/04/2016
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Provider Practice Location Address
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Address Line | 5115 CHURCH ST SUITE 100
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City | SKOKIE
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State | IL
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Zip | 60077-1201
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Country | US
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Telephone | 847-677-4933
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Fax | 847-679-3973
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Provider Business Mailing Address
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Address Line | 5115 CHURCH ST SUITE 100
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City | SKOKIE
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State | IL
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Zip | 60077-1201
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Country | US
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Telephone | 847-677-4933
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Fax | 847-679-3973
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 200000006C
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License Number State | IL
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