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Organization

PROTECTING THE PAC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ANNA SHAY LEWIS (PRESIDENT)
(773) 858-3115
Entity
Organization

Contact information

Practice address
14500 S DEARBORN ST, RIVERDALE, IL 60827-2859
(773) 858-3115
Mailing address
11611 S ABERDEEN ST, CHICAGO, IL 60643-5150
(773) 858-3115

Taxonomy

Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
253Z00000X
In Home Supportive Care Agency
Primary
261QD1600X
Developmental Disabilities Clinic/Center
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility

Other

Enumeration date
11/12/2021
Last updated
11/12/2021
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