Healthcare Provider Details

I. General information

NPI: 1477508265
Provider Name (Legal Business Name): NEW DIRECTION OUTREACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6857 S STATE ST
CHICAGO IL
60637-3910
US

IV. Provider business mailing address

6857 S STATE ST
CHICAGO IL
60637-3910
US

V. Phone/Fax

Practice location:
  • Phone: 773-483-2226
  • Fax: 773-224-8201
Mailing address:
  • Phone: 773-483-2226
  • Fax: 773-224-8201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. STEPHEN JEROME LAFLORA
Title or Position: EXECUTIVE DIRECTOR
Credential: M.S.
Phone: 773-483-2226