Healthcare Provider Details

I. General information

NPI: 1699537068
Provider Name (Legal Business Name): SANDSTONE CARE ILLINOIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2024
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16325 HARLEM AVE STE 200
TINLEY PARK IL
60477-1688
US

IV. Provider business mailing address

7555 E HAMPDEN AVE STE 103
DENVER CO
80231-4832
US

V. Phone/Fax

Practice location:
  • Phone: 888-228-2384
  • Fax: 888-850-1860
Mailing address:
  • Phone: 888-228-2384
  • Fax: 888-850-1860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIA MORALES
Title or Position: DIRECTOR OF REVENUE OPERATIONS
Credential:
Phone: 720-647-4467