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General NPI Number Information
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NPI Number | 1982860813
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Entity Type | Organization
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Legal Business Name | TEENS IN ACTION, INC.
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Dates
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Enumeration Date | 07/30/2008
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Last Update Date | 07/30/2008
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Provider Practice Location Address
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Address Line | 1015 E 149TH ST
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City | EAST CHICAGO
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State | IN
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Zip | 46312-3771
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Country | US
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Telephone | 219-397-5117
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Fax |
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Provider Business Mailing Address
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Address Line | 1015 E 149TH ST
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City | EAST CHICAGO
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State | IN
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Zip | 46312-3771
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Country | US
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Telephone | 219-397-5117
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. BRIDGETTE L SPANN
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Credential |
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Telephone | 219-397-5117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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