MEDICARE: SONIA SHANKMAN ORTHOGENIC SCHOOL

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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility

General Provider Information

NPI Number	:	1851866867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONIA SHANKMAN ORTHOGENIC SCHOOL

Provider Business Mailing Address
First Line	:	SONIA SHANKMAN ORTHOGENIC SCHOOL
Second Line	:	6245 SOUTH INGLESIDE AVE
City	:	CHICAGO
State	:	IL
Zip	:	60637-2621
Country	:	US
Telephone Number	:	773-420-2883
Fax Number	:	773-420-2804

Provider Business Practice Location Address
First Line	:	SONIA SHANKMAN ORTHOGENIC SCHOOL
Second Line	:	6245 SOUTH INGLESIDE AVE
City	:	CHICAGO
State	:	IL
Zip	:	60637-2621
Country	:	US
Telephone Number	:	773-420-2883
Fax Number	:	773-420-2804

Authorized Official
Title or Position	:	CFO
Name	:	ABBY SIMON
Credential	:
Telephone Number	:	773-420-2883

Provider Enumeration Date	:	10/05/2018
Last Update Date	:	10/05/2018

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