MEDICARE: LITTLE CITY FOUNDATION

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
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility		IL

General Provider Information

NPI Number	:	1063767291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE CITY FOUNDATION

Provider Business Mailing Address
First Line	:	1760 W ALGONQUIN RD
Second Line	:
City	:	PALATINE
State	:	IL
Zip	:	60067-4791
Country	:	US
Telephone Number	:	847-358-5510
Fax Number	:

Provider Business Practice Location Address
First Line	:	1640 S. LITTLE CITY DRIVE
Second Line	:
City	:	PALATINE
State	:	IL
Zip	:	60067
Country	:	US
Telephone Number	:	847-358-5510
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. SHAWN JEFFERS
Credential	:
Telephone Number	:	847-358-5510

Provider Enumeration Date	:	07/13/2012
Last Update Date	:	02/14/2020

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Directions to “LITTLE CITY FOUNDATION ” Practice Location

Language	Start Address	Practice Location

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