Provider Demographics
NPI:1275863730
Name:HIGH FIVE KIDS, INC.
Entity Type:Organization
Organization Name:HIGH FIVE KIDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CONSULTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BALTHASAR
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:773-348-0238
Mailing Address - Street 1:1327 W CORNELIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1401
Mailing Address - Country:US
Mailing Address - Phone:414-303-8847
Mailing Address - Fax:
Practice Address - Street 1:1327 W CORNELIA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1401
Practice Address - Country:US
Practice Address - Phone:414-303-8847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health