Provider Demographics
NPI:1700419298
Name:THE PLAYROOM PRO, INC.
Entity Type:Organization
Organization Name:THE PLAYROOM PRO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KATES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-602-1110
Mailing Address - Street 1:555 VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:IL
Mailing Address - Zip Code:60022-1643
Mailing Address - Country:US
Mailing Address - Phone:847-602-1110
Mailing Address - Fax:
Practice Address - Street 1:555 VERNON AVE
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:IL
Practice Address - Zip Code:60022-1643
Practice Address - Country:US
Practice Address - Phone:847-602-1110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health