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General NPI Number Information
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NPI Number | 1740940741
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Entity Type | Organization
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Legal Business Name | BRAIN BOX LITERACY ACADEMY AND EDUCATIONAL SERVICES
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Dates
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Enumeration Date | 12/19/2021
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Last Update Date | 12/19/2021
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Provider Practice Location Address
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Address Line | 9304 S ASHLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60620-5119
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Country | US
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Telephone | 773-230-9682
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Fax | 773-424-3000
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Provider Business Mailing Address
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Address Line | 1510 KINROSS ST
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City | FLOSSMOOR
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State | IL
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Zip | 60422-4314
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Country | US
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Telephone | 773-230-9682
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Fax | 773-424-3000
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | AYESHA ELAMIN
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Credential |
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Telephone | 773-230-9682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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