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General NPI Number Information
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NPI Number | 1649404716
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Entity Type | Organization
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Legal Business Name | UCP SEGUIN OF GREATER CHICAGO
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Dates
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Enumeration Date | 05/05/2009
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Last Update Date | 06/13/2023
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Provider Practice Location Address
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Address Line | 3100 S CENTRAL AVE
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City | CICERO
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State | IL
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Zip | 60804-3956
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Country | US
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Telephone | 708-222-4248
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Fax | 708-222-0478
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Provider Business Mailing Address
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Address Line | 3100 S CENTRAL AVE
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City | CICERO
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State | IL
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Zip | 60804-3956
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Country | US
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Telephone | 708-222-4248
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Fax | 708-222-0478
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT
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Name | MR. THOMAS LEONARD FOLEY
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Credential |
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Telephone | 708-222-4248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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