Healthcare Provider Details

I. General information

NPI: 1235307158
Provider Name (Legal Business Name): CARITAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 N ASHLAND AVE
CHICAGO IL
60607-1802
US

IV. Provider business mailing address

1301 W 22ND ST STE 500
OAK BROOK IL
60523-2014
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberC/A-0554-0001-A
License Number StateIL

VIII. Authorized Official

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