MEDICARE: STEP OF FAITH 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	251S00000X	Community/Behavioral Health Agency	64704079	IL

General Provider Information

NPI Number	:	1801118096
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEP OF FAITH INC

Provider Business Mailing Address
First Line	:	4627 S STATE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-4602
Country	:	US
Telephone Number	:	773-268-3644
Fax Number	:	773-268-3654

Provider Business Practice Location Address
First Line	:	4627 S STATE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-4602
Country	:	US
Telephone Number	:	773-268-3644
Fax Number	:	773-268-3654

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MRS. LORRAINE MCKINNEY
Credential	:
Telephone Number	:	773-268-3644

Provider Enumeration Date	:	02/16/2010
Last Update Date	:	02/16/2010

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Directions to “STEP OF FAITH INC ” Practice Location

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