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General NPI Number Information
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NPI Number | 1598330581
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Entity Type | Organization
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Legal Business Name | REACHING 4 R SISTERS
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Dates
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Enumeration Date | 05/23/2021
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Last Update Date | 05/23/2021
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Provider Practice Location Address
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Address Line | 3604 W POLK ST
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City | CHICAGO
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State | IL
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Zip | 60624-4384
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Country | US
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Telephone | 773-632-9711
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Fax |
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Provider Business Mailing Address
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Address Line | 3604 W POLK ST
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City | CHICAGO
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State | IL
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Zip | 60624-4384
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Country | US
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Telephone | 773-632-9711
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | MRS. JESSECA WATSON
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Credential |
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Telephone | 331-442-1127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number |
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License Number State |
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