Provider Demographics
NPI:1225346893
Name:1ST STEPS TO SUCCESS
Entity Type:Organization
Organization Name:1ST STEPS TO SUCCESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BILLUPS CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-310-0600
Mailing Address - Street 1:909 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-1981
Mailing Address - Country:US
Mailing Address - Phone:708-310-0600
Mailing Address - Fax:708-620-5317
Practice Address - Street 1:209 CANDLEWICK RD
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-1303
Practice Address - Country:US
Practice Address - Phone:319-240-2119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00725251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAX000402816Medicaid