Healthcare Provider Details

I. General information

NPI: 1821953902
Provider Name (Legal Business Name): PADS LAKE COUNTY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 GRAND AVE
WAUKEGAN IL
60085-3582
US

IV. Provider business mailing address

1800 GRAND AVE
WAUKEGAN IL
60085-3582
US

V. Phone/Fax

Practice location:
  • Phone: 847-689-4357
  • Fax: 847-689-0509
Mailing address:
  • Phone: 847-689-4357
  • Fax: 847-689-0509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIC FOOTE
Title or Position: DIRECTOR OF FINANCE & OPERATIONS
Credential:
Phone: 847-689-0597