Provider Demographics
NPI:1295985786
Name:AFG GUIDANCE CENTER LTD
Entity type:Organization
Organization Name:AFG GUIDANCE CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFREDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FALKOWSKA-GROSRENAUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-733-1461
Mailing Address - Street 1:820 SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2513
Mailing Address - Country:US
Mailing Address - Phone:847-733-1461
Mailing Address - Fax:847-733-1470
Practice Address - Street 1:820 SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-2513
Practice Address - Country:US
Practice Address - Phone:847-733-1461
Practice Address - Fax:847-733-1470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360929522084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036092952Medicaid
ILH05595Medicare UPIN