MEDICARE: AUSTIN SPECIAL CHICAGO

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	199700018C	IL
2	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1356706246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUSTIN SPECIAL CHICAGO

Provider Business Mailing Address
First Line	:	5318 N ELSTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-1611
Country	:	US
Telephone Number	:	773-282-9992
Fax Number	:	773-282-1749

Provider Business Practice Location Address
First Line	:	5318 N ELSTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-1611
Country	:	US
Telephone Number	:	773-282-9992
Fax Number	:	773-282-1749

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. MARICEL R ABAN
Credential	:
Telephone Number	:	773-282-9992

Provider Enumeration Date	:	12/21/2015
Last Update Date	:	12/21/2015

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Directions to “AUSTIN SPECIAL CHICAGO ” Practice Location

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