MEDICARE: LESTER AND ROSALIE ANIXTER CENTER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	251C00000X	Developmentally Disabled Services Day Training Agency
3	251S00000X	Community/Behavioral Health Agency
4	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1134576788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LESTER AND ROSALIE ANIXTER CENTER

Provider Business Mailing Address
First Line	:	6610 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-4062
Country	:	US
Telephone Number	:	773-761-1501
Fax Number	:	773-977-1240

Provider Business Practice Location Address
First Line	:	6610 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-4062
Country	:	US
Telephone Number	:	773-761-1501
Fax Number	:	773-977-1240

Authorized Official
Title or Position	:	SENIOR DIRECTOR OF FINANCE
Name	:	MS. MARY DESMOND
Credential	:
Telephone Number	:	773-761-1501

Provider Enumeration Date	:	05/24/2016
Last Update Date	:	05/31/2016

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