Provider Demographics
NPI:1972374528
Name:LOCAL WORX COMMUNITY SPACE
Entity Type:Organization
Organization Name:LOCAL WORX COMMUNITY SPACE
Other - Org Name:A BRIGHT CENTER INTEGRATED LIVING - IL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAREON
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:331-207-0188
Mailing Address - Street 1:9923 RIDGELAND AVE # 118
Mailing Address - Street 2:
Mailing Address - City:CHICAGO RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60415-1262
Mailing Address - Country:US
Mailing Address - Phone:331-207-0188
Mailing Address - Fax:
Practice Address - Street 1:22239 WILLOW TREE AVE
Practice Address - Street 2:
Practice Address - City:SAUK VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60411-5159
Practice Address - Country:US
Practice Address - Phone:331-207-0188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-12
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities