Healthcare Provider Details

I. General information

NPI: 1093202558
Provider Name (Legal Business Name): THE THRESHOLDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4875 N MAGNOLIA AVE
CHICAGO IL
60640-4756
US

IV. Provider business mailing address

4101 N RAVENSWOOD AVE
CHICAGO IL
60613-2193
US

V. Phone/Fax

Practice location:
  • Phone: 773-572-5500
  • Fax:
Mailing address:
  • Phone: 773-572-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AL SHOREIBAH
Title or Position: CFO
Credential:
Phone: 773-572-5262