Provider Demographics
NPI:1508041542
Name:MOSAIC CHILDHOOD PROJECT, INC.
Entity Type:Organization
Organization Name:MOSAIC CHILDHOOD PROJECT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC/SLP
Authorized Official - Phone:773-575-6215
Mailing Address - Street 1:1333 W NORTH SHORE AVE
Mailing Address - Street 2:3N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-4767
Mailing Address - Country:US
Mailing Address - Phone:773-575-6215
Mailing Address - Fax:773-341-7376
Practice Address - Street 1:1333 W NORTH SHORE AVE
Practice Address - Street 2:3N
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-4767
Practice Address - Country:US
Practice Address - Phone:773-575-6215
Practice Address - Fax:773-341-7376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health