Healthcare Provider Details

I. General information

NPI: 1720640642
Provider Name (Legal Business Name): FAMILY GUIDANCE CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2924 STANTON ST
SPRINGFIELD IL
62703-4315
US

IV. Provider business mailing address

2618 PATRIOT BLVD
GLENVIEW IL
60026-8024
US

V. Phone/Fax

Practice location:
  • Phone: 217-441-6529
  • 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

VIII. Authorized Official

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