Healthcare Provider Details

I. General information

NPI: 1326511882
Provider Name (Legal Business Name): FAMILY GUIDANCE CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 W EVERGREEN ST
MANTENO IL
60950-9329
US

IV. Provider business mailing address

2618 PATRIOT BLVD
GLENVIEW IL
60026-8024
US

V. Phone/Fax

Practice location:
  • Phone: 815-468-6556
  • Fax:
Mailing address:
  • Phone: 224-659-7030
  • Fax: 224-659-7035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: BRIAN NOTTAGE
Title or Position: VICE PRESIDENT
Credential:
Phone: 312-943-6545