Provider Demographics
NPI:1063565190
Name:MELI DEVELOPMENT CENTER
Entity type:Organization
Organization Name:MELI DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALABA-YUSOUF
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:630-783-1850
Mailing Address - Street 1:542 E BOUGHTON RD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-2181
Mailing Address - Country:US
Mailing Address - Phone:630-783-1850
Mailing Address - Fax:
Practice Address - Street 1:542 E BOUGHTON RD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2181
Practice Address - Country:US
Practice Address - Phone:630-783-1850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-20
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006045101YP2500X
IL1490113691041C0700X
IL1490127081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09932455OtherBLUE CROSS BLUE SHIELD