MEDICARE: GUILDHAUS

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	324500000X	Substance Abuse Rehabilitation Facility	A09910002A	IL

General Provider Information

NPI Number	:	1689890287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUILDHAUS

Provider Business Mailing Address
First Line	:	2413 CANAL ST
Second Line	:
City	:	BLUE ISLAND
State	:	IL
Zip	:	60406-2926
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2413 CANAL ST
Second Line	:
City	:	BLUE ISLAND
State	:	IL
Zip	:	60406-2926
Country	:	US
Telephone Number	:	708-385-3228
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. FRANK TOVAR
Credential	:
Telephone Number	:	708-385-3228

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	08/22/2020

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Directions to “GUILDHAUS ” Practice Location

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