Provider Demographics
NPI:1366055899
Name:CHILDREN'S HABILITATION CENTER
Entity type:Organization
Organization Name:CHILDREN'S HABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANMARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-722-2946
Mailing Address - Street 1:121 W 154TH ST
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426-3552
Mailing Address - Country:US
Mailing Address - Phone:708-596-2220
Mailing Address - Fax:708-596-2258
Practice Address - Street 1:121 W 154TH ST
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-3552
Practice Address - Country:US
Practice Address - Phone:708-596-2220
Practice Address - Fax:708-596-2258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility