Healthcare Provider Details

I. General information

NPI: 1194896944
Provider Name (Legal Business Name): OMNI YOUTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W LAKE COOK RD
BUFFALO GROVE IL
60089-1926
US

IV. Provider business mailing address

1111 W LAKE COOK RD
BUFFALO GROVE IL
60089-1926
US

V. Phone/Fax

Practice location:
  • Phone: 847-353-1500
  • Fax:
Mailing address:
  • Phone: 847-353-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number036-078-450
License Number StateIL

VIII. Authorized Official

Name: MRS. DORYCE MCCARTHY
Title or Position: CFO
Credential:
Phone: 847-353-1758