MEDICARE: NO LOOKING BACK 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	261QR0800X	Recovery Care Clinic/Center

General Provider Information

NPI Number	:	1881269876
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NO LOOKING BACK NFP

Provider Business Mailing Address
First Line	:	11440 S INDIANA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60628-4954
Country	:	US
Telephone Number	:	773-632-9711
Fax Number	:

Provider Business Practice Location Address
First Line	:	11440 S INDIANA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60628-4954
Country	:	US
Telephone Number	:	773-632-9711
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	MRS. JESSECA WATSON
Credential	:
Telephone Number	:	331-442-1127

Provider Enumeration Date	:	05/23/2021
Last Update Date	:	05/23/2021

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