Organization
JANASTON MANAGEMENT & DEVELOPMENT CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROLAND EDWARD WESLEY PH.D (CEO)
(773) 261-0075
Entity
Organization
Contact information
Practice address
4942 W DIVISION ST, CHICAGO, IL 60651-3158
(773) 261-0075
(773) 261-0084
Mailing address
4942 W DIVISION ST, CHICAGO, IL 60651-3158
(773) 261-0075
(773) 261-0084
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
946213
IL
347C00000X
Private Vehicle
YESU
IL
Other
Enumeration date
10/27/2009
Last updated
10/27/2009
Update your record
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