Healthcare Provider Details

I. General information

NPI: 1447716568
Provider Name (Legal Business Name): PATHOS CHICAGO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 W ERIE ST STE 205
CHICAGO IL
60654-7692
US

IV. Provider business mailing address

430 W ERIE ST STE 205
CHICAGO IL
60654-7692
US

V. Phone/Fax

Practice location:
  • Phone: 312-792-3610
  • Fax:
Mailing address:
  • Phone: 312-584-6635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT HILLIKER
Title or Position: FOUNDER
Credential:
Phone: 713-470-9878