Healthcare Provider Details

I. General information

NPI: 1609493709
Provider Name (Legal Business Name): CARITAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2020
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 N ASHLAND AVE
CHICAGO IL
60607-1802
US

IV. Provider business mailing address

1301 W 22ND ST STE 500
OAK BROOK IL
60523-2014
US

V. Phone/Fax

Practice location:
  • Phone: 312-850-9411
  • Fax: 312-850-3288
Mailing address:
  • Phone: 630-572-8228
  • Fax: 630-570-0566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JESSECA WATSON
Title or Position: CONTRACTS AND CREDENTIALING MANAGER
Credential:
Phone: 630-572-8228