MEDICARE: GROW WITH M.E. 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	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1548682776
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROW WITH M.E. INC.

Provider Business Mailing Address
First Line	:	1507 E 53RD ST
Second Line	:	SUITE 848
City	:	CHICAGO
State	:	IL
Zip	:	60615-4573
Country	:	US
Telephone Number	:	630-414-1823
Fax Number	:	855-763-2747

Provider Business Practice Location Address
First Line	:	1507 E 53RD ST
Second Line	:	SUITE 848
City	:	CHICAGO
State	:	IL
Zip	:	60615-4573
Country	:	US
Telephone Number	:	630-414-1823
Fax Number	:	855-763-2747

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. MIGUEL MENDEZ
Credential	:
Telephone Number	:	630-414-1823

Provider Enumeration Date	:	01/07/2014
Last Update Date	:	01/07/2014

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