MEDICARE: ADA S. MCKINLEY COMMUNITY SERVICES, INC.

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	001	IL
2	315P00000X	Intellectual Disabilities Intermediate Care Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0030601	OTHER	IL	IDPH LICENSE

General Provider Information

NPI Number	:	1437401668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADA S. MCKINLEY COMMUNITY SERVICES, INC.

Provider Business Mailing Address
First Line	:	1359 W WASHINGTON BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-1905
Country	:	US
Telephone Number	:	312-385-2000
Fax Number	:	312-554-0292

Provider Business Practice Location Address
First Line	:	6600 S STEWART AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60621-3112
Country	:	US
Telephone Number	:	773-994-0775
Fax Number	:	773-994-8722

Authorized Official
Title or Position	:	DIR QA&C
Name	:	KEN FRIES
Credential	:
Telephone Number	:	630-744-9431

Provider Enumeration Date	:	10/11/2012
Last Update Date	:	05/06/2025

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