Provider Demographics
NPI:1285030106
Name:STANDING IN THE GAP INCORPORATED
Entity Type:Organization
Organization Name:STANDING IN THE GAP INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANTE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:708-209-7640
Mailing Address - Street 1:304 NEW SALEM ST
Mailing Address - Street 2:
Mailing Address - City:PARK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60466-1137
Mailing Address - Country:US
Mailing Address - Phone:708-209-7640
Mailing Address - Fax:
Practice Address - Street 1:304 NEW SALEM ST
Practice Address - Street 2:
Practice Address - City:PARK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60466-1137
Practice Address - Country:US
Practice Address - Phone:708-209-7640
Practice Address - Fax:708-481-0816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management