Healthcare Provider Details

I. General information

NPI: 1851688907
Provider Name (Legal Business Name): BEACON THERAPEUTIC SCHOOLS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2011
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10650 S LONGWOOD DR
CHICAGO IL
60643-2617
US

IV. Provider business mailing address

1912 W 103RD ST
CHICAGO IL
60643-2625
US

V. Phone/Fax

Practice location:
  • Phone: 773-881-1005
  • Fax: 773-298-1078
Mailing address:
  • Phone: 773-298-1243
  • Fax: 773-298-1078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CHERYL THOMPSON
Title or Position: DEPUTY CEO
Credential:
Phone: 773-298-1243