MEDICARE: THE THRESHOLDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1083861975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE THRESHOLDS

Provider Business Mailing Address
First Line	:	4101 N RAVENSWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-2193
Country	:	US
Telephone Number	:	773-572-5500
Fax Number	:	773-537-3488

Provider Business Practice Location Address
First Line	:	3909 RAYCRAFT RD
Second Line	:
City	:	WOODSTOCK
State	:	IL
Zip	:	60098-8307
Country	:	US
Telephone Number	:	773-572-5500
Fax Number	:	773-537-3488

Authorized Official
Title or Position	:	CFO
Name	:	AL SHOREIBAH
Credential	:
Telephone Number	:	773-572-5262

Provider Enumeration Date	:	08/21/2008
Last Update Date	:	04/18/2018

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Directions to “THE THRESHOLDS ” Practice Location

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