Provider Demographics
NPI:1740516640
Name:JANASTON MANAGEMENT & DEVELOPMENT CORP
Entity type:Organization
Organization Name:JANASTON MANAGEMENT & DEVELOPMENT CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:WESLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:773-261-0075
Mailing Address - Street 1:4942 W DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60651-3158
Mailing Address - Country:US
Mailing Address - Phone:773-261-0075
Mailing Address - Fax:773-261-0084
Practice Address - Street 1:4942 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651-3158
Practice Address - Country:US
Practice Address - Phone:773-261-0075
Practice Address - Fax:773-261-0084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL946213320900000X
ILYESU347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No347C00000XTransportation ServicesPrivate Vehicle