Healthcare Provider Details

I. General information

NPI: 1437532694
Provider Name (Legal Business Name): RESK RESIDENTIAL SERVICES INC,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6127 S UNIVERSITY AVE
CHICAGO IL
60637-5894
US

IV. Provider business mailing address

6127 S UNIVERSITY AVE
CHICAGO IL
60637-5894
US

V. Phone/Fax

Practice location:
  • Phone: 312-721-2471
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34007290A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.017928
License Number StateIL

VIII. Authorized Official

Name: MRS. SANDRA HUNTER BASS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 312-721-2471