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General NPI Number Information
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NPI Number | 1750219416
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Entity Type | Organization
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Legal Business Name | ST NICHOLAS CILA HOMES CORPORATION
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Dates
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Enumeration Date | 05/12/2026
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Last Update Date | 05/12/2026
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Provider Practice Location Address
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Address Line | 6204 OLD PLANK BLVD
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City | MATTESON
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State | IL
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Zip | 60443-1453
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Country | US
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Telephone | 773-240-9225
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Fax | 773-240-9225
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Provider Business Mailing Address
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Address Line | 8734 CARLISLE CT
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City | DARIEN
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State | IL
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Zip | 60561-5372
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Country | US
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Telephone | 773-240-9225
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Fax | 773-240-9225
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Authorized Official
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Title or Position | PRESIDENT
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Name | NICHOLAS EFOSA AGBONIFO
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Credential |
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Telephone | 773-240-9225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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