Healthcare Provider Details

I. General information

NPI: 1457895732
Provider Name (Legal Business Name): THE THRESHOLDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2016
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2847 N CLARK ST
CHICAGO IL
60657-5207
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:
  • 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 TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number04133
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARCELLA KLAUER
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 773-572-5480