Healthcare Provider Details

I. General information

NPI: 1376680512
Provider Name (Legal Business Name): CARITAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 NORTH ASHLAND AVENUE
CHICAGO IL
60607
US

IV. Provider business mailing address

1301 WEST 22ND STREET SUITE 500
OAK BROOK IL
60523
US

V. Phone/Fax

Practice location:
  • Phone: 312-850-9411
  • Fax: 312-850-3288
Mailing address:
  • Phone: 630-572-0556
  • Fax: 630-572-0566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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