Provider Demographics
NPI:1932518131
Name:DECOACH, INC
Entity Type:Organization
Organization Name:DECOACH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRYCJA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUDOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-905-7135
Mailing Address - Street 1:3320 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60131-1514
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3320 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:IL
Practice Address - Zip Code:60131-1514
Practice Address - Country:US
Practice Address - Phone:630-999-6619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-13
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency