Organization
GARDEN OF PARYER YOUTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL MALONEY (EXECUTIVE DIRECTOR)
(815) 933-2493
Entity
Organization
Contact information
Practice address
657 E COURT ST, KANKAKEE, IL 60901-4055
(815) 933-2493
(815) 933-2494
Mailing address
657 E COURT ST, KANKAKEE, IL 60901-4055
(815) 933-2493
(815) 933-2494
Taxonomy
Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
Primary
041-129-294
IL
251V00000X
Voluntary or Charitable Agency
180-0007-145
IL
251V00000X
Voluntary or Charitable Agency
180-006-235
IL
Other
Enumeration date
10/17/2011
Last updated
10/17/2011
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