Healthcare Provider Details

I. General information

NPI: 1043129604
Provider Name (Legal Business Name): SPECTRUMONE CARE ILLINOIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 S DANTE AVE
CHICAGO IL
60619-7118
US

IV. Provider business mailing address

2646 HIGHWAY AVE
HIGHLAND IN
46322-1661
US

V. Phone/Fax

Practice location:
  • Phone: 833-717-4244
  • Fax:
Mailing address:
  • Phone: 833-717-4244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JASMINE C BANKHEAD
Title or Position: CEO
Credential: RN
Phone: 773-606-8002