Healthcare Provider Details
I. General information
NPI: 1710775044
Provider Name (Legal Business Name): RADIUS FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 04/28/2025
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1014 MAIN ST
CRETE IL
60417-1911
US
IV. Provider business mailing address
11952 S HARLEM AVE STE 100
PALOS HEIGHTS IL
60463-1386
US
V. Phone/Fax
- Phone: 708-847-1002
- Fax: 708-847-1004
- Phone: 708-923-0800
- Fax: 708-923-0800
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103K00000X |
| Taxonomy | Behavior Analyst |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 261QM2800X |
| Taxonomy | Methadone Clinic |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 261QR0405X |
| Taxonomy | Substance Use Disorder Rehabilitation Clinic/Center |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
WILLIAM
J
BRAMLETT
Title or Position: OWNER
Credential:
Phone: 773-507-4695