MEDICARE: INNOCENT CHILDREN 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	251S00000X	Community/Behavioral Health Agency
2	305S00000X	Point of Service

General Provider Information

NPI Number	:	1477850550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOCENT CHILDREN FOUNDATION

Provider Business Mailing Address
First Line	:	836 S. ARLINGTON HEIGHTS RD
Second Line	:	195
City	:	ELK GROVE
State	:	IL
Zip	:	60007
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	836 S ARLINGTON HEIGHTS RD
Second Line	:	195
City	:	ELK GROVE VLG
State	:	IL
Zip	:	60007-3667
Country	:	US
Telephone Number	:	312-545-2211
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AMANDA PARISI
Credential	:
Telephone Number	:	312-545-2211

Provider Enumeration Date	:	02/25/2011
Last Update Date	:	02/25/2011

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Directions to “INNOCENT CHILDREN FOUNDATION ” Practice Location

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