Provider Demographics
NPI:1811019656
Name:BLUE ISLAND CITIZENS FOR PERSONS WITH DEVELOPMENTAL DISABILITIES
Entity Type:Organization
Organization Name:BLUE ISLAND CITIZENS FOR PERSONS WITH DEVELOPMENTAL DISABILITIES
Other - Org Name:BLUE CAP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOUIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-389-6578
Mailing Address - Street 1:2155 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-3050
Mailing Address - Country:US
Mailing Address - Phone:708-389-6578
Mailing Address - Fax:708-389-5086
Practice Address - Street 1:2155 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-3050
Practice Address - Country:US
Practice Address - Phone:708-389-6578
Practice Address - Fax:708-389-5086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services