MEDICARE: 'THERE'S NO PLACE LIKE HOME' MICROBOARD, INC.

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	201100001C	IL

General Provider Information

NPI Number	:	1093087645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	'THERE'S NO PLACE LIKE HOME' MICROBOARD, INC.

Provider Business Mailing Address
First Line	:	2813 S HIELAND RD
Second Line	:
City	:	SAINT ANNE
State	:	IL
Zip	:	60964-5566
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2813 S HIELAND RD
Second Line	:
City	:	SAINT ANNE
State	:	IL
Zip	:	60964-5566
Country	:	US
Telephone Number	:	815-954-5621
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. MEGAN ZEBIO
Credential	:
Telephone Number	:	773-960-3071

Provider Enumeration Date	:	01/29/2012
Last Update Date	:	01/29/2012

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