Healthcare Provider Details

I. General information

NPI: 1104059864
Provider Name (Legal Business Name): CARITAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2009
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 N ASHLAND AVE
CHICAGO IL
60607-1802
US

IV. Provider business mailing address

1301 W 22ND ST SUITE 800
OAK BROOK IL
60523-2006
US

V. Phone/Fax

Practice location:
  • Phone: 312-850-0050
  • Fax: 312-850-9095
Mailing address:
  • Phone: 630-572-8228
  • Fax: 630-572-0566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number07008
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

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