Provider Demographics
NPI:1851576599
Name:WARD HOUSE SUPPORTIVE SERVICES, INC
Entity Type:Organization
Organization Name:WARD HOUSE SUPPORTIVE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:773-846-1589
Mailing Address - Street 1:1049 W 87TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620-3328
Mailing Address - Country:US
Mailing Address - Phone:773-846-1589
Mailing Address - Fax:
Practice Address - Street 1:1049 W 87TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-3328
Practice Address - Country:US
Practice Address - Phone:773-846-1589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILMEDICAID PENDINGOtherMEDICAID PENDING