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NPI Code Detail

MEDICARE: THE LADY ESTHER PROJECT FOUNDATION

MEDICARE: THE LADY ESTHER PROJECT 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
1251B00000XCase Management Agency
2251C00000XDevelopmentally Disabled Services Day Training Agency
3251K00000XPublic Health or Welfare Agency
4251S00000XCommunity/Behavioral Health Agency
5302R00000XHealth Maintenance Organization
63245S0500XChildren's Substance Abuse Rehabilitation Facility
7101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1477158210
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE LADY ESTHER PROJECT FOUNDATION
Provider Business Mailing Address
First Line : 3473 S KING DR # 492
Second Line :
City : CHICAGO
State : IL
Zip : 60616-4108
Country : US
Telephone Number : 773-937-1992
Fax Number :
Provider Business Practice Location Address
First Line : 2761 W 86TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60652-3933
Country : US
Telephone Number : 773-937-1992
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : TONESIA N ROUSE
Credential : MHA, FACHE
Telephone Number : 773-937-1992
Provider Enumeration Date : 12/01/2020
Last Update Date : 12/01/2020

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Directions to “THE LADY ESTHER PROJECT FOUNDATION ” Practice Location

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