Provider Demographics
NPI:1356639082
Name:CYNTHIAS CERAMIC PAINT A GIFT HOBBY STUDIO
Entity Type:Organization
Organization Name:CYNTHIAS CERAMIC PAINT A GIFT HOBBY STUDIO
Other - Org Name:PROGRESS IN MOTION
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-648-1429
Mailing Address - Street 1:10625 S MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-2707
Mailing Address - Country:US
Mailing Address - Phone:773-648-1429
Mailing Address - Fax:773-568-0832
Practice Address - Street 1:10625 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-2707
Practice Address - Country:US
Practice Address - Phone:773-648-1429
Practice Address - Fax:773-568-0832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health