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General NPI Number Information
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NPI Number | 1831083997
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Entity Type | Organization
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Legal Business Name | HONEYSUCKLE HOME INC
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Dates
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Enumeration Date | 06/04/2025
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 4017 W OGDEN AVE
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City | CHICAGO
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State | IL
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Zip | 60623-2820
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Country | US
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Telephone | 773-512-6193
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Fax |
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Provider Business Mailing Address
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Address Line | 4017 W OGDEN AVE
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City | CHICAGO
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State | IL
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Zip | 60623-2820
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Country | US
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Telephone | 773-512-6193
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Fax |
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Authorized Official
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Title or Position | DON/ PROGRAM ADMINISTRATOR/ OWNER
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Name | CRYSTAL TRINIDAD
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Credential | NP
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Telephone | 773-512-6193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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