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General NPI Number Information
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NPI Number | 1851995039
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Entity Type | Organization
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Legal Business Name | A BEAUTIFUL MIND, INC
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Dates
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Enumeration Date | 11/28/2020
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Last Update Date | 12/08/2021
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Provider Practice Location Address
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Address Line | 5113 S HARPER AVE STE 2C
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City | CHICAGO
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State | IL
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Zip | 60615-4119
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Country | US
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Telephone | 773-304-3699
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Fax |
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Provider Business Mailing Address
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Address Line | 5113 S HARPER AVE # 2C
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City | CHICAGO
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State | IL
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Zip | 60615-4119
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Country | US
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Telephone | 773-304-3699
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Fax |
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Authorized Official
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Title or Position | CEO/FOUNDER
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Name | CHIQUITA LEE
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Credential |
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Telephone | 773-304-3699
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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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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 |
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