Healthcare Provider Details

I. General information

NPI: 1376392787
Provider Name (Legal Business Name): TRILOGY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2024
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 N HIAWATHA AVE
CHICAGO IL
60646-4309
US

IV. Provider business mailing address

1400 W GREENLEAF AVE
CHICAGO IL
60626-2805
US

V. Phone/Fax

Practice location:
  • Phone: 773-508-6100
  • Fax:
Mailing address:
  • Phone: 815-650-0886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH SEELOW
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 815-650-0886