Healthcare Provider Details

I. General information

NPI: 1720534100
Provider Name (Legal Business Name): HENRY'S SOBER LIVING HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2016
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8032 S INGLESIDE AVE
CHICAGO IL
60619-4223
US

IV. Provider business mailing address

8032 S INGLESIDE AVE
CHICAGO IL
60619-4223
US

V. Phone/Fax

Practice location:
  • Phone: 773-752-1300
  • Fax: 773-752-1302
Mailing address:
  • Phone: 773-752-1300
  • Fax: 773-752-1302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HENRY D. MCGHEE JR.
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 773-752-1300