Way Back Inn

NPI 1093060741 - Counselor - 101YA0400X

NPI Details
NPI 1093060741
Enumeration Date 07/18/2012
Last Updated 07/18/2012
Entity Type Healthcare Provider
Active Over 4 years ago
Authorized Information
Name ANITA MARIA ANITA
Position INTERIM EXECUTIVE DIRECTOR
Phone (708) 344-3301
Fax (708) 344-2944
Practice Location
1915 W ROOSEVELT RD
BROADVIEW IL, 60155-2925, US
Phone (708) 344-3301
Fax (708) 344-2944
Business Location
1915 W ROOSEVELT RD
BROADVIEW IL, 60155-2925, US
Phone (708) 344-3301
Fax (708) 344-2944
Toxanomy
Taxonomy Code 101YA0400X
License State Illinois
License Number 180.007316
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According to our database, Way Back Inn NPI is 1093060741, taxonomy code is 101YA0400X and license number is 180.007316, license state is located at Illinois. Way Back Inn physically located at 1915 W Roosevelt Rd, Broadview IL, 60155-2925. NPI Number 1033115704 has the healthcare provider type.

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1093060741 NPI number is provided on an as is basis without warranty of any kind. 1093060741 is maintained by the National Plan & Provider Enumeration System. The contents of Way Back Inn are for informational purposes only.