Organization
SHAW COMMUNITY INTEGRATION SERVICES
Active
Other names
SCIS Agency
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RHONDA JEFFERSON RN (REGISTERED NURSE)
(773) 952-1965
Entity
Organization
Contact information
Practice address
8119 S VERNON AVE, CHICAGO, IL 60619-4913
(773) 952-1965
(708) 810-9792
Mailing address
8119 S VERNON AVE # 1, CHICAGO, IL 60619-4913
(773) 952-1965
(708) 810-9792
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/05/2020
Last updated
02/05/2020
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