Provider Demographics
NPI:1407268691
Name:BOTTLES TO SOON
Entity Type:Organization
Organization Name:BOTTLES TO SOON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTER NURSE
Authorized Official - Prefix:
Authorized Official - First Name:MARA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-683-8987
Mailing Address - Street 1:9731 S INGLESIDE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-1517
Mailing Address - Country:US
Mailing Address - Phone:773-683-8987
Mailing Address - Fax:
Practice Address - Street 1:9731 S INGLESIDE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-1517
Practice Address - Country:US
Practice Address - Phone:773-683-8987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0413802123140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric