Healthcare Provider Details

I. General information

NPI: 1184840969
Provider Name (Legal Business Name): GLENKIRK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 DUNDEE RD
NORTHBROOK IL
60062-2303
US

IV. Provider business mailing address

3300 DUNDEE RD
NORTHBROOK IL
60062-2303
US

V. Phone/Fax

Practice location:
  • Phone: 847-272-5111
  • Fax:
Mailing address:
  • Phone: 847-272-5111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: NICOLE MARIE ZANON-TOCKE
Title or Position: ADMINISTRATOR
Credential: LCPC, NCC
Phone: 847-272-5111