Healthcare Provider Details

I. General information

NPI: 1962135848
Provider Name (Legal Business Name): SANDSTONE CARE ILLINOIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 N ARLINGTON HEIGHTS RD
BUFFALO GROVE IL
60089-8211
US

IV. Provider business mailing address

7555 E HAMPDEN AVE STE 103
DENVER CO
80231-4832
US

V. Phone/Fax

Practice location:
  • Phone: 720-372-0218
  • Fax: 888-850-1860
Mailing address:
  • Phone: 888-228-2384
  • Fax: 888-850-1860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JESSE VICK
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 720-356-0752