=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598372096
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE PIECE THAT FITS DAYCARE AND ABA THERAPY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2020
-----------------------------------------------------
Last Update Date | 09/28/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18037 RIDGEWOOD AVE
-----------------------------------------------------
City | LANSING
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60438-2253
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-571-6330
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18037 RIDGEWOOD AVE
-----------------------------------------------------
City | LANSING
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60438-2253
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-571-6330
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER / CEO
-----------------------------------------------------
Name | MS. KRYSTLE GORE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 773-571-6330
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------