Healthcare Provider Details

I. General information

NPI: 1992973689
Provider Name (Legal Business Name): SPECIALIZED ASSISTANCE SERVICES, NFP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 S. WABASH
CHICAGO IL
60616
US

IV. Provider business mailing address

2630 S. WABASH
CHICAGO IL
60616
US

V. Phone/Fax

Practice location:
  • Phone: 312-808-3218
  • Fax: 312-791-9037
Mailing address:
  • Phone: 312-808-3218
  • Fax: 312-791-9037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberA-0584-0001A
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: BELINDA MORENO
Title or Position: VP FINANCE & ADMINISTRATION
Credential:
Phone: 312-808-3218