Healthcare Provider Details

I. General information

NPI: 1497353551
Provider Name (Legal Business Name): EXCEPTIONAL CASE MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12904 DIVISION ST APT 2A
BLUE ISLAND IL
60406-3420
US

IV. Provider business mailing address

12904 DIVISION ST APT 2A
BLUE ISLAND IL
60406-3420
US

V. Phone/Fax

Practice location:
  • Phone: 773-236-6511
  • Fax:
Mailing address:
  • Phone: 773-236-6511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. LINDA ODANIEL
Title or Position: CEO
Credential: PHD
Phone: 773-236-6511