Healthcare Provider Details

I. General information

NPI: 1639348691
Provider Name (Legal Business Name): YSL CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5107-21 WEST JACKSON BLVD
CHICAGO IL
60644
US

IV. Provider business mailing address

5107-21 WEST JACKSON BLVD
CHICAGO IL
60644
US

V. Phone/Fax

Practice location:
  • Phone: 773-378-5490
  • Fax: 773-378-7860
Mailing address:
  • Phone: 773-378-5490
  • Fax: 773-378-7860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number0007781
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. AFZAL LOKHANDWALA
Title or Position: PRESIDENT
Credential:
Phone: 630-664-6048