Provider Demographics
NPI:1467994822
Name:GARDEN CENTER SERVISES
Entity Type:Organization
Organization Name:GARDEN CENTER SERVISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL SUPPORT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JE'SHONA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVERETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-991-6180
Mailing Address - Street 1:12244 S ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-5412
Mailing Address - Country:US
Mailing Address - Phone:773-991-6180
Mailing Address - Fax:
Practice Address - Street 1:12244 S ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-5412
Practice Address - Country:US
Practice Address - Phone:773-991-6180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health