Provider Demographics
NPI:1235791112
Name:ENRICHING CREATIVE MINDS EARLY INTERVENTION LLC
Entity Type:Organization
Organization Name:ENRICHING CREATIVE MINDS EARLY INTERVENTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEVELOPMENTAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LORELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAUGARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-257-2781
Mailing Address - Street 1:PO BOX 703
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-0703
Mailing Address - Country:US
Mailing Address - Phone:708-257-2781
Mailing Address - Fax:815-524-5718
Practice Address - Street 1:557 S CANYON DR
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-4309
Practice Address - Country:US
Practice Address - Phone:708-257-2781
Practice Address - Fax:815-524-5718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency