Provider Demographics
NPI:1821494741
Name:CHILDREN'S THERAPY CENTER
Entity Type:Organization
Organization Name:CHILDREN'S THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:MARGARITA
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:COTA
Authorized Official - Phone:312-600-8493
Mailing Address - Street 1:2946 189TH PL
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-3426
Mailing Address - Country:US
Mailing Address - Phone:708-955-2213
Mailing Address - Fax:708-575-6882
Practice Address - Street 1:8729 S COMMERCIAL
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617
Practice Address - Country:US
Practice Address - Phone:312-600-8493
Practice Address - Fax:708-575-6882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056007283251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services