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General NPI Number Information
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NPI Number | 1992054498
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Entity Type | Organization
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Legal Business Name | ERIC FAMILY SERVICES, INC.
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Dates
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Enumeration Date | 08/30/2012
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Last Update Date | 08/30/2012
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Provider Practice Location Address
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Address Line | 4452 W THOMAS ST
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City | CHICAGO
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State | IL
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Zip | 60651-3406
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Country | US
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Telephone | 773-384-9755
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 N AUSTIN AVE # 205
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City | CHICAGO
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State | IL
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Zip | 60639-5010
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Country | US
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Telephone | 773-745-3742
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. EVANEE NEVILLE
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Credential |
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Telephone | 773-745-3742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 149015143
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License Number State | IL
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