Organization
A PLACE RESTORATION 9
Active
Other names
a place restoration
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. IVAN C JAMES MSW (PROGRAM DIRECTOR)
(773) 317-4900
Entity
Organization
Contact information
Practice address
8023 S INDIANA AVE, CHICAGO, IL 60619-3506
(773) 317-4900
Mailing address
8023 S INDIANA AVE, CHICAGO, IL 60619-3506
(773) 317-4900
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
IL
Other
Enumeration date
10/08/2010
Last updated
10/08/2010
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