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NPI Code Detail

MEDICARE: SEGUIN SERVICES

MEDICARE: SEGUIN SERVICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1320900000XIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number : 1023267358
Entity Type Code : Organization
Provider Name (Legal Business Name) : SEGUIN SERVICES
Provider Business Mailing Address
First Line : 3100 S CENTRAL AVE
Second Line :
City : CICERO
State : IL
Zip : 60804-3956
Country : US
Telephone Number : 708-863-3803
Fax Number :
Provider Business Practice Location Address
First Line : 3100 S CENTRAL AVE
Second Line :
City : CICERO
State : IL
Zip : 60804-3956
Country : US
Telephone Number : 708-863-3803
Fax Number :
Authorized Official
Title or Position : BEHAVIORAL SPECIALIST
Name : RENEE DIANE QUINNETT
Credential :
Telephone Number : 847-772-3693
Provider Enumeration Date : 09/10/2008
Last Update Date : 09/10/2008

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1053740597 — MS. DONNA LYNN RESSLER ROBINSON
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Directions to “SEGUIN SERVICES ” Practice Location

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