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State of Illinois

NPI #1609890235 in Chicago, Illinois

Provider Information

NPI Number
1609890235
Entity Type
Organization
Organization Name
State of Illinois
Primary Specialty
Residential Treatment Facility, Physical Disabilities
Enumeration Date
Jul 27, 2006
Last Updated
Aug 22, 2020

Practice Location

Address
2424W.CHARLESTON
City
Chicago
State
Illinois
ZIP Code
60647
Phone
(773) 276-8863

Authorized Official

Name
MR. CHRIS GREENWOOD
Title
CASEMANAGER
Phone
(312) 666-3494

Specialties & Taxonomy Codes

Specialty
Residential Treatment Facility, Physical Disabilities

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