Healthcare Provider Details

I. General information

NPI: 1639585110
Provider Name (Legal Business Name): WOMEN'S RESIDENTIAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 07/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24647 N MILWAUKEE AVE
VERNON HILLS IL
60061-1567
US

IV. Provider business mailing address

3412A UNIVERSITY CIR
NORTH CHICAGO IL
60064-3080
US

V. Phone/Fax

Practice location:
  • Phone: 847-377-7950
  • Fax:
Mailing address:
  • Phone: 815-545-3572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. MARGO PRESTON
Title or Position: DIRECTOR
Credential:
Phone: 847-377-7950