Healthcare Provider Details

I. General information

NPI: 1053625061
Provider Name (Legal Business Name): THE THRESHOLDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2010
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5511 N ARTESIAN AVE
CHICAGO IL
60625-2686
US

IV. Provider business mailing address

4101 N RAVENSWOOD AVE
CHICAGO IL
60613-2193
US

V. Phone/Fax

Practice location:
  • Phone: 773-572-5500
  • Fax:
Mailing address:
  • Phone: 773-572-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MARCELLA KLAUER
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 773-572-5480