State of Illinois Department of Human Services

NPI #1962954099 in Chicago, Illinois

Provider Information

NPI Number
1962954099
Entity Type
Organization
Organization Name
State of Illinois Department of Human Services
Primary Specialty
Custodial Care Facility - Adult Care Home
Enumeration Date
Oct 24, 2016
Last Updated
Oct 24, 2016

Practice Location

Address
10724 S INDIANA AVE
ZIP Code
60628-3615
Phone
(312) 513-4566

Authorized Official

Name
NATASHA CRAIG
Title
CNA / HOME HEALTH AID
Phone
(312) 513-4566

Specialties & Taxonomy Codes

Specialty
Custodial Care Facility - Adult Care HomeAdult Care Home

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