MEDICARE: THE BOULEVARD

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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1265209308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE BOULEVARD

Provider Business Mailing Address
First Line	:	542 S DEARBORN ST FL 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-1508
Country	:	US
Telephone Number	:	630-903-3331
Fax Number	:

Provider Business Practice Location Address
First Line	:	3456 W FRANKLIN BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60624-1308
Country	:	US
Telephone Number	:	630-903-3331
Fax Number	:

Authorized Official
Title or Position	:	CHIEF PROGRAM OFFICER
Name	:	KATHLEEN RECCHIA
Credential	:	LSW, MS
Telephone Number	:	630-903-3331

Provider Enumeration Date	:	12/08/2023
Last Update Date	:	03/12/2024

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Directions to “THE BOULEVARD ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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