Healthcare Provider Details

I. General information

NPI: 1124988480
Provider Name (Legal Business Name): HENDRICKSON HOUSE OF SOBRIETY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 S 49TH AVE
CICERO IL
60804-3634
US

IV. Provider business mailing address

4949 N NORMANDY AVE
CHICAGO IL
60656-4001
US

V. Phone/Fax

Practice location:
  • Phone: 464-927-9879
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEVE HENDRICKSON
Title or Position: OWNER
Credential:
Phone: 612-685-4958