Healthcare Provider Details

I. General information

NPI: 1225063472
Provider Name (Legal Business Name): CLEARBROOK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1835 W CENTRAL ROAD
ARLINGTON HEIGHTS IL
60005-2410
US

IV. Provider business mailing address

1835 W CENTRAL ROAD
ARLINGTON HEIGHTS IL
60005-2410
US

V. Phone/Fax

Practice location:
  • Phone: 847-870-7711
  • Fax: 847-870-7741
Mailing address:
  • Phone: 847-870-7711
  • Fax: 847-870-7741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. CARL M LA MELL
Title or Position: PRESIDENT
Credential:
Phone: 847-870-7711