Healthcare Provider Details

I. General information

NPI: 1114801743
Provider Name (Legal Business Name): CHICAGO CHILDREN'S ADVOCACY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 S DAMEN AVE
CHICAGO IL
60608-1122
US

IV. Provider business mailing address

1240 S DAMEN AVE
CHICAGO IL
60608-1122
US

V. Phone/Fax

Practice location:
  • Phone: 312-492-3183
  • Fax:
Mailing address:
  • Phone: 312-492-3183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHAR RIVETTE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 312-492-3729