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General NPI Number Information
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NPI Number | 1568743482
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Entity Type | Organization
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Legal Business Name | HAVE DREAMS
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Dates
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Enumeration Date | 09/06/2011
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Last Update Date | 09/06/2011
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Provider Practice Location Address
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Address Line | 515 BUSSE HWY 150
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City | PARK RIDGE
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State | IL
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Zip | 60068-3154
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Country | US
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Telephone | 847-685-0250
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Fax | 847-685-0257
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Provider Business Mailing Address
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Address Line | 515 BUSSE HWY 150
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City | PARK RIDGE
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State | IL
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Zip | 60068-3154
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Country | US
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Telephone | 847-685-0250
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Fax | 847-685-0257
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. KRIS JOHNSEN
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Credential | MA
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Telephone | 847-685-0250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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