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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 Facility

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 : 1518034693
Entity Type Code : Organization
Provider Name (Legal Business Name) : MCDERMOTT CENTER
Provider Business Mailing Address
First Line : 120 N SANGAMON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60607-2202
Country : US
Telephone Number : 312-226-7984
Fax Number : 312-226-8048
Provider Business Practice Location Address
First Line : 108 N SANGAMON ST FL 2
Second Line :
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 : DR. DAN LUSTIG
Credential :
Telephone Number : 312-226-7984
Provider Enumeration Date : 11/30/2006
Last Update Date : 04/09/2022

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1184002206 — MCDERMOTT CENTER
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Directions to “MCDERMOTT CENTER ” Practice Location

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