Provider Demographics
NPI:1255744975
Name:CHILDREN'S THERAPY CENTER
Entity type:Organization
Organization Name:CHILDREN'S THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLIS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:312-600-8493
Mailing Address - Street 1:8729 S COMMERCIAL AVE
Mailing Address - Street 2:STORE FRONT
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-3221
Mailing Address - Country:US
Mailing Address - Phone:312-600-8493
Mailing Address - Fax:
Practice Address - Street 1:8729 S COMMERCIAL AVE
Practice Address - Street 2:STORE FRONT
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-3221
Practice Address - Country:US
Practice Address - Phone:312-600-8493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056007283320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities