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General NPI Number Information
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NPI Number | 1851741888
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Entity Type | Organization
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Legal Business Name | ASSOCIATION HOUSE OF CHICAGO
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Dates
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Enumeration Date | 06/21/2016
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Last Update Date | 06/21/2016
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Provider Practice Location Address
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Address Line | 2849 W WALTON ST
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City | CHICAGO
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State | IL
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Zip | 60622-4448
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Country | US
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Telephone | 773-435-3205
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Fax | 773-395-7340
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Provider Business Mailing Address
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Address Line | 1116 N KEDZIE AVE
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City | CHICAGO
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State | IL
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Zip | 60651-4152
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Country | US
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Telephone | 773-772-8009
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Fax | 773-292-5490
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. HARRIET SADAUSKAS
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Credential |
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Telephone | 773-772-8009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management 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 | 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 | IL
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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Taxonomy #5
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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 | IL
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