Provider Demographics
NPI:1649629346
Name:CATINA BALLIN
Entity type:Organization
Organization Name:CATINA BALLIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DSP
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATINA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:BALLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-390-4665
Mailing Address - Street 1:8808 RILEY RD
Mailing Address - Street 2:
Mailing Address - City:WONDER LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60097-8986
Mailing Address - Country:US
Mailing Address - Phone:630-390-4665
Mailing Address - Fax:
Practice Address - Street 1:8808 RILEY ROAD
Practice Address - Street 2:
Practice Address - City:WONDERLAKE
Practice Address - State:IL
Practice Address - Zip Code:60097
Practice Address - Country:US
Practice Address - Phone:630-390-4666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities