Healthcare Provider Details

I. General information

NPI: 1902283641
Provider Name (Legal Business Name): MCDERMOTT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2015
Last Update Date: 04/09/2022
Certification Date: 04/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 N SANGAMON ST FL 6
CHICAGO IL
60607-2202
US

IV. Provider business mailing address

932 W WASHINGTON BLVD
CHICAGO IL
60607-2217
US

V. Phone/Fax

Practice location:
  • Phone: 312-226-7984
  • Fax: 312-226-8048
Mailing address:
  • Phone: 312-226-7984
  • Fax: 312-226-8048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberA-0349-0038-A
License Number StateIL

VIII. Authorized Official

Name: DR. DAN LUSTIG
Title or Position: PRESIDENT & CEO
Credential:
Phone: 312-226-7984