Organization
BOTTLES TO SOON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARA DENISE WILSON (REGISTER NURSE)
(773) 683-8987
Entity
Organization
Contact information
Practice address
9731 S INGLESIDE AVE, CHICAGO, IL 60628-1517
(773) 683-8987
Mailing address
9731 S INGLESIDE AVE, CHICAGO, IL 60628-1517
(773) 683-8987
Taxonomy
Speciality
Code
Description
License number
State
3140N1450X
Pediatric Skilled Nursing Facility
Primary
041380212
IL
Other
Enumeration date
05/22/2014
Last updated
05/22/2014
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