Provider Demographics
NPI:1861621757
Name:UNLIMITED POTENTIAL 1 INC.
Entity type:Organization
Organization Name:UNLIMITED POTENTIAL 1 INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOLENIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-581-1446
Mailing Address - Street 1:8539 N OLCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-2051
Mailing Address - Country:US
Mailing Address - Phone:847-581-1446
Mailing Address - Fax:847-983-8175
Practice Address - Street 1:8539 N OLCOTT AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-2051
Practice Address - Country:US
Practice Address - Phone:847-581-1446
Practice Address - Fax:847-983-8175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-13
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty