MEDICARE: NICASA, NFP

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	A-0614-0002
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1841614294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICASA, NFP

Provider Business Mailing Address
First Line	:	31979 N FISH LAKE RD
Second Line	:
City	:	ROUND LAKE
State	:	IL
Zip	:	60073-9517
Country	:	US
Telephone Number	:	847-546-6450
Fax Number	:	847-546-6760

Provider Business Practice Location Address
First Line	:	2031 DUGDALE RD
Second Line	:
City	:	NORTH CHICAGO
State	:	IL
Zip	:	60064-1928
Country	:	US
Telephone Number	:	847-785-8660
Fax Number	:	847-546-6760

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	MRS. LINDA SNELTEN
Credential	:
Telephone Number	:	847-546-6450

Provider Enumeration Date	:	02/05/2014
Last Update Date	:	04/06/2021

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