Healthcare Provider Details

I. General information

NPI: 1457413882
Provider Name (Legal Business Name): FAMILY GUIDANCE CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

484 LEE ST
DES PLAINES IL
60016-4610
US

IV. Provider business mailing address

2618 PATRIOT BLVD
GLENVIEW IL
60026-8024
US

V. Phone/Fax

Practice location:
  • Phone: 847-827-7517
  • Fax: 847-827-2707
Mailing address:
  • Phone: 224-659-7030
  • Fax: 224-659-7035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberA05210007A
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License NumberA05210007A
License Number StateIL

VIII. Authorized Official

Name: BRIAN NOTTAGE
Title or Position: VICE PRESIDENT
Credential: MA, LPC, NCC
Phone: 312-943-6545