Provider Demographics
NPI:1518416163
Name:EASTER SEALS METROPOLITAN CHICAGO
Entity Type:Organization
Organization Name:EASTER SEALS METROPOLITAN CHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAWACKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-491-4110
Mailing Address - Street 1:1939 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-1236
Mailing Address - Country:US
Mailing Address - Phone:312-491-4110
Mailing Address - Fax:
Practice Address - Street 1:17300 OZARK AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2693
Practice Address - Country:US
Practice Address - Phone:708-429-8231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management