MEDICARE: A PLACE RESTORATION 9

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	320800000X	Mental Illness Community Based Residential Treatment Facility		IL

General Provider Information

NPI Number	:	1942510961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A PLACE RESTORATION 9

Provider Business Mailing Address
First Line	:	8023 S INDIANA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60619-3506
Country	:	US
Telephone Number	:	773-317-4900
Fax Number	:

Provider Business Practice Location Address
First Line	:	8023 S INDIANA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60619-3506
Country	:	US
Telephone Number	:	773-317-4900
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MRS. IVAN C JAMES
Credential	:	MSW
Telephone Number	:	773-317-4900

Provider Enumeration Date	:	10/08/2010
Last Update Date	:	10/08/2010

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Directions to “A PLACE RESTORATION 9 ” Practice Location

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