Provider Demographics
NPI: | 1356596753 |
---|---|
Name: | BARBARA OLSON CENTER OF HOPE |
Entity type: | Organization |
Organization Name: | BARBARA OLSON CENTER OF HOPE |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | CARM |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HERMAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 815-964-9275 |
Mailing Address - Street 1: | 3206 N CENTRAL AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | ROCKFORD |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 61101-1756 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 815-964-9275 |
Mailing Address - Fax: | 815-964-9607 |
Practice Address - Street 1: | 3206 N CENTRAL AVE |
Practice Address - Street 2: | |
Practice Address - City: | ROCKFORD |
Practice Address - State: | IL |
Practice Address - Zip Code: | 61101-1756 |
Practice Address - Country: | US |
Practice Address - Phone: | 815-964-9275 |
Practice Address - Fax: | 815-964-9607 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-11-26 |
Last Update Date: | 2011-11-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | Group - Multi-Specialty | |
No | 163W00000X | Nursing Service Providers | Registered Nurse | Group - Multi-Specialty | |
No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 225XF0002X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Feeding, Eating & Swallowing | Group - Multi-Specialty |
No | 225XH1300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Human Factors | Group - Multi-Specialty |
No | 225XN1300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Neurorehabilitation | Group - Multi-Specialty |
No | 225XP0019X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation | Group - Multi-Specialty |