Provider Demographics
NPI:1508890435
Name:CITY KIDS, INC.
Entity Type:Organization
Organization Name:CITY KIDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KACY
Authorized Official - Middle Name:
Authorized Official - Last Name:HERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:773-467-5669
Mailing Address - Street 1:5669 N NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-6153
Mailing Address - Country:US
Mailing Address - Phone:773-467-5669
Mailing Address - Fax:773-631-2926
Practice Address - Street 1:5669 N NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-6153
Practice Address - Country:US
Practice Address - Phone:773-467-5669
Practice Address - Fax:773-631-2926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01619276OtherBCBSIL PROVIDER ID NUMBER