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General NPI Number Information
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NPI Number | 1760852230
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Entity Type | Organization
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Legal Business Name | CENTERS FOR RESIDENTIAL ALTERNATIVES
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Dates
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Enumeration Date | 09/28/2015
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Last Update Date | 09/28/2015
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Provider Practice Location Address
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Address Line | 625 E 170TH ST SUITE 2 - E
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-3479
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Country | US
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Telephone | 708-339-3100
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Fax | 708-339-3200
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Provider Business Mailing Address
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Address Line | 625 E 170TH ST SUITE 2 - E
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-3479
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Country | US
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Telephone | 708-339-3100
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Fax | 708-339-3200
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. EUGENE HUMPHREY III
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Credential |
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Telephone | 708-339-3100
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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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