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General NPI Number Information
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NPI Number | 1952067043
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Entity Type | Organization
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Legal Business Name | PROTECTING THE PAC
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Dates
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Enumeration Date | 11/12/2021
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Last Update Date | 11/12/2021
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Provider Practice Location Address
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Address Line | 14500 S DEARBORN ST
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City | RIVERDALE
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State | IL
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Zip | 60827-2859
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Country | US
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Telephone | 773-858-3115
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Fax |
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Provider Business Mailing Address
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Address Line | 11611 S ABERDEEN ST
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City | CHICAGO
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State | IL
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Zip | 60643-5150
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Country | US
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Telephone | 773-858-3115
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANNA SHAY LEWIS
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Credential |
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Telephone | 773-858-3115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care 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 | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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