Healthcare Provider Details

I. General information

NPI: 1689158156
Provider Name (Legal Business Name): CARITAS CENTRAL INTAKE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 NORTH ASHLAND AVENUE
CHICAGO IL
60607
US

IV. Provider business mailing address

1301 WEST 22ND STREET SUITE 500
OAK BROOK IL
60523
US

V. Phone/Fax

Practice location:
  • Phone: 312-850-9411
  • Fax: 312-850-3288
Mailing address:
  • Phone: 630-572-8228
  • Fax: 312-572-0566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: JESSECA WATSON
Title or Position: CNTRACTS AND CREDENTIALING MANAGER
Credential:
Phone: 630-572-8228