Organization
SUPPORTED INDEPENDENCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JESSICA LUCKETT (PRESIDENT)
(630) 667-7370
Entity
Organization
Contact information
Practice address
17009 ELM DRIVE, HAZEL CREST, IL 60429
(630) 667-7370
Mailing address
17900 ELM DRIVE, HAZEL CREST, IL 60429
(630) 667-7370
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
12/08/2011
Last updated
12/08/2011
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