Provider Demographics
NPI:1063720282
Name:CHILDREN'S RESEARCH TRIANGLE
Entity type:Organization
Organization Name:CHILDREN'S RESEARCH TRIANGLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHASNOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-726-4011
Mailing Address - Street 1:180 N MICHIGAN AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7487
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:180 N MICHIGAN AVE STE 700
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7487
Practice Address - Country:US
Practice Address - Phone:312-726-4011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007454251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health