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General NPI Number Information
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NPI Number | 1942510961
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Entity Type | Organization
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Legal Business Name | A PLACE RESTORATION 9
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Dates
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Enumeration Date | 10/08/2010
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Last Update Date | 10/08/2010
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Provider Practice Location Address
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Address Line | 8023 S INDIANA AVE
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City | CHICAGO
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State | IL
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Zip | 60619-3506
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Country | US
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Telephone | 773-317-4900
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Fax |
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Provider Business Mailing Address
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Address Line | 8023 S INDIANA AVE
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City | CHICAGO
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State | IL
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Zip | 60619-3506
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Country | US
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Telephone | 773-317-4900
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MRS. IVAN C JAMES
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Credential | MSW
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Telephone | 773-317-4900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State | IL
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