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General NPI Number Information
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NPI Number | 1922330802
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Entity Type | Organization
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Legal Business Name | ABC LANGUAGE CLUBHOUSE INC
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Dates
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Enumeration Date | 02/03/2010
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Last Update Date | 02/03/2010
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Provider Practice Location Address
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Address Line | 10769 BROADWAY SUITE 225
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City | CROWN POINT
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State | IN
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Zip | 46307-7310
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Country | US
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Telephone | 630-340-1629
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Fax |
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Provider Business Mailing Address
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Address Line | 10769 BROADWAY SUITE 225
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City | CROWN POINT
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State | IN
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Zip | 46307-7310
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Country | US
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Telephone | 630-340-1629
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. TONYA ALCORN
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Credential |
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Telephone | 630-340-1629
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 146006464
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License Number State | IL
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