Provider Demographics
NPI:1538798939
Name:FARLAND, MITTIE
Entity type:Individual
Prefix:
First Name:MITTIE
Middle Name:
Last Name:FARLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 YORK ST APT 2F
Mailing Address - Street 2:
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-2568
Mailing Address - Country:US
Mailing Address - Phone:708-829-9723
Mailing Address - Fax:
Practice Address - Street 1:858 BURNHAM AVE
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-4728
Practice Address - Country:US
Practice Address - Phone:708-891-5429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator