Provider Demographics
NPI:1518237528
Name:AFG GUIDANCE CENTER KENILWORTH, INC.
Entity Type:Organization
Organization Name:AFG GUIDANCE CENTER KENILWORTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFREDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FALKOWSKA-GROSRENAUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-510-5013
Mailing Address - Street 1:444 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:KENILWORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60043-1001
Mailing Address - Country:US
Mailing Address - Phone:847-853-0234
Mailing Address - Fax:847-853-0230
Practice Address - Street 1:444 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:KENILWORTH
Practice Address - State:IL
Practice Address - Zip Code:60043-1001
Practice Address - Country:US
Practice Address - Phone:847-853-0234
Practice Address - Fax:847-853-0230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036092952261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health