Healthcare Provider Details

I. General information

NPI: 1962847699
Provider Name (Legal Business Name): SPECIALIZED HEALTH CARE SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4909 W HURON ST
CHICAGO IL
60644-1334
US

IV. Provider business mailing address

4909 W HURON ST
CHICAGO IL
60644-1334
US

V. Phone/Fax

Practice location:
  • Phone: 773-688-5092
  • Fax: 773-379-6983
Mailing address:
  • Phone: 773-688-5092
  • Fax: 773-379-6983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: REGINA DIANA LEWIS
Title or Position: CEO/OWNER
Credential:
Phone: 773-688-5092