Healthcare Provider Details

I. General information

NPI: 1871361956
Provider Name (Legal Business Name): NORTHEAST FAMILY SERVICES OF ILLINOIS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 S MICHIGAN AVE
CHICAGO IL
60616-2857
US

IV. Provider business mailing address

2348 POST RD STE 107
WARWICK RI
02886-2271
US

V. Phone/Fax

Practice location:
  • Phone: 224-275-1712
  • Fax:
Mailing address:
  • Phone: 978-530-6605
  • Fax:

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 Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NIDHI TURNER
Title or Position: COO
Credential:
Phone: 978-530-6605