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Organization

ACHIEVE DEVELOPMENT ASSOCIATION INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. MARIA GROSU (EXECUTIVE DIRECTOR)
(847) 677-4933
Entity
Organization

Contact information

Practice address
5115 CHURCH ST, SUITE 100, SKOKIE, IL 60077-1201
(847) 677-4933
(847) 679-3973
Mailing address
5115 CHURCH ST, SUITE 100, SKOKIE, IL 60077-1201
(847) 677-4933
(847) 679-3973

Taxonomy

Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
200000006C
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
3000006
MCO PLAN
IL
01
7094638
BILLING AGENCY
IL
Enumeration date
05/17/2016
Last updated
05/17/2016
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