Organization
ABC LANGUAGE CLUBHOUSE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TONYA ALCORN (PRESIDENT)
(630) 340-1629
Entity
Organization
Contact information
Practice address
10769 BROADWAY, SUITE 225, CROWN POINT, IN 46307-7310
(630) 340-1629
Mailing address
10769 BROADWAY, SUITE 225, CROWN POINT, IN 46307-7310
(630) 340-1629
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
146006464
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2233168
BLUE BROSS BLUE SHIELD
IL
Enumeration date
02/03/2010
Last updated
02/03/2010
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