Provider Demographics
NPI:1063684678
Name:EASTER SEALS METROPOLITAN CHICAGO
Entity Type:Organization
Organization Name:EASTER SEALS METROPOLITAN CHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAWACKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-491-4110
Mailing Address - Street 1:1939 W 13TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-1236
Mailing Address - Country:US
Mailing Address - Phone:312-491-4110
Mailing Address - Fax:312-733-0247
Practice Address - Street 1:1939 W 13TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1236
Practice Address - Country:US
Practice Address - Phone:312-491-4110
Practice Address - Fax:312-733-0247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========010Medicaid
IL=========011Medicaid