Supported Independence
NPI #1649548405 in Hazel Crest, Illinois
Provider Information
- NPI Number
- 1649548405
- Entity Type
- Organization
- Organization Name
- Supported Independence
- Primary Specialty
- Community/Behavioral Health
- Enumeration Date
- Dec 8, 2011
- Last Updated
- Dec 8, 2011
Practice Location
- Address
- 17009 ELM DRIVE
- City
- Hazel Crest
- State
- Illinois
- ZIP Code
- 60429
- Phone
- (630) 667-7370
Authorized Official
- Name
- MRS. JESSICA LUCKETT
- Title
- PRESIDENT
- Phone
- (630) 667-7370
Specialties & Taxonomy Codes
| Specialty |
|---|
| Community/Behavioral Health |
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