Healthcare Provider Details

I. General information

NPI: 1124102611
Provider Name (Legal Business Name): FAMILY GUIDANCE CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W CHICAGO AVE
CHICAGO IL
60654-5106
US

IV. Provider business mailing address

2618 PATRIOT BLVD
GLENVIEW IL
60026-8024
US

V. Phone/Fax

Practice location:
  • Phone: 312-943-6545
  • Fax: 312-943-6543
Mailing address:
  • Phone: 224-659-7030
  • Fax: 224-659-7035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberA05210002
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License NumberA05210002
License Number StateIL

VIII. Authorized Official

Name: MR. BRIAN NOTTAGE
Title or Position: VICE PRESIDENT
Credential: MA, LPC, NCC
Phone: 312-943-6545