MEDICARE: THRESHOLDS

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1578994901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRESHOLDS

Provider Business Mailing Address
First Line	:	4101 N RAVENSWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-2193
Country	:	US
Telephone Number	:	773-572-5500
Fax Number	:

Provider Business Practice Location Address
First Line	:	4423 N RAVENSWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5802
Country	:	US
Telephone Number	:	773-572-5500
Fax Number	:

Authorized Official
Title or Position	:	VP
Name	:	MARK FURLONG
Credential	:
Telephone Number	:	773-572-5390

Provider Enumeration Date	:	12/11/2013
Last Update Date	:	12/11/2013

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