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NPI Code Detail

MEDICARE: MCDERMOTT CENTER

MEDICARE: MCDERMOTT CENTER
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
1324500000XSubstance Abuse Rehabilitation FacilityA-0349-0049-AIL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356729479
Entity Type Code : Organization
Provider Name (Legal Business Name) : MCDERMOTT CENTER
Provider Business Mailing Address
First Line : 932 W WASHINGTON BLVD
Second Line :
City : CHICAGO
State : IL
Zip : 60607-2217
Country : US
Telephone Number : 312-226-7984
Fax Number :
Provider Business Practice Location Address
First Line : 124 N SANGAMON ST
Second Line : 6TH FLOOR
City : CHICAGO
State : IL
Zip : 60607-2202
Country : US
Telephone Number : 312-226-7984
Fax Number : 312-226-8048
Authorized Official
Title or Position : PRESIDENT & CEO
Name : MR. DAN LUSTIG
Credential :
Telephone Number : 312-226-7984
Provider Enumeration Date : 05/08/2015
Last Update Date : 04/09/2022

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Directions to “MCDERMOTT CENTER ” Practice Location

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