Provider Demographics
NPI:1225364078
Name:LITTLE CITY FOUNDATION
Entity Type:Organization
Organization Name:LITTLE CITY FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-358-5510
Mailing Address - Street 1:700 N SACRAMENTO BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-1046
Mailing Address - Country:US
Mailing Address - Phone:773-265-2539
Mailing Address - Fax:773-265-1755
Practice Address - Street 1:700 N SACRAMENTO BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-1046
Practice Address - Country:US
Practice Address - Phone:773-265-2539
Practice Address - Fax:773-265-1755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-29
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3B00-IPI-053251S00000X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health