Provider Demographics
NPI:1659067858
Name:NURTURING DEVELOPING MINDS
Entity Type:Organization
Organization Name:NURTURING DEVELOPING MINDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-408-1320
Mailing Address - Street 1:1025 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-1111
Mailing Address - Country:US
Mailing Address - Phone:708-408-1320
Mailing Address - Fax:
Practice Address - Street 1:1025 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-1111
Practice Address - Country:US
Practice Address - Phone:708-408-1320
Practice Address - Fax:708-647-1709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty