Provider Demographics
NPI:1366817447
Name:DEVORA'S DREAM, INC
Entity Type:Organization
Organization Name:DEVORA'S DREAM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-558-4509
Mailing Address - Street 1:2323 OLD GLENVIEW RD
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-3113
Mailing Address - Country:US
Mailing Address - Phone:224-558-4509
Mailing Address - Fax:847-256-1824
Practice Address - Street 1:2323 OLD GLENVIEW RD
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-3113
Practice Address - Country:US
Practice Address - Phone:224-558-4509
Practice Address - Fax:847-256-1824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities