Organization
WALKING IN HIS PURPOSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIWANNA BASS (REGISTER NURSE)
(773) 757-3814
Entity
Organization
Contact information
Practice address
19609 LAKE SHORE DR, LYNWOOD, IL 60411-1473
(773) 757-3814
Mailing address
19609 LAKE SHORE DR, LYNWOOD, IL 60411-1473
(773) 757-3814
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
05/17/2021
Last updated
05/17/2021
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