MEDICARE: BRAIN BOX LITERACY ACADEMY AND EDUCATIONAL SERVICES

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	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1740940741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAIN BOX LITERACY ACADEMY AND EDUCATIONAL SERVICES

Provider Business Mailing Address
First Line	:	1510 KINROSS ST
Second Line	:
City	:	FLOSSMOOR
State	:	IL
Zip	:	60422-4314
Country	:	US
Telephone Number	:	773-230-9682
Fax Number	:	773-424-3000

Provider Business Practice Location Address
First Line	:	9304 S ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60620-5119
Country	:	US
Telephone Number	:	773-230-9682
Fax Number	:	773-424-3000

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	AYESHA ELAMIN
Credential	:
Telephone Number	:	773-230-9682

Provider Enumeration Date	:	12/19/2021
Last Update Date	:	12/19/2021

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