Provider Demographics
NPI:1194993626
Name:NURTURING INDIVIDUALS NEEDING ASSISTANCE
Entity type:Organization
Organization Name:NURTURING INDIVIDUALS NEEDING ASSISTANCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MANTECA
Authorized Official - Suffix:
Authorized Official - Credentials:DEVTHERAPIST
Authorized Official - Phone:708-862-4323
Mailing Address - Street 1:2020 RIVER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-5074
Mailing Address - Country:US
Mailing Address - Phone:708-862-4323
Mailing Address - Fax:708-862-4315
Practice Address - Street 1:2020 RIVER OAKS DRIVE
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-5074
Practice Address - Country:US
Practice Address - Phone:708-862-4323
Practice Address - Fax:708-862-4315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency