MEDICARE: YOUTH SERVICE PROJECT

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		IL

General Provider Information

NPI Number	:	1578731501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUTH SERVICE PROJECT

Provider Business Mailing Address
First Line	:	3942 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4639
Country	:	US
Telephone Number	:	773-772-6270
Fax Number	:	773-772-8755

Provider Business Practice Location Address
First Line	:	3942 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4639
Country	:	US
Telephone Number	:	773-772-6270
Fax Number	:	773-772-8755

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. GINA ZUNIGA-BALDWIN III
Credential	:
Telephone Number	:	773-772-6270

Provider Enumeration Date	:	02/12/2008
Last Update Date	:	07/21/2022

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