Healthcare Provider Details

I. General information

NPI: 1134369663
Provider Name (Legal Business Name): OMNI YOUTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2009
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N WOLF RD
WHEELING IL
60090-2922
US

IV. Provider business mailing address

1111 W LAKE COOK RD
BUFFALO GROVE IL
60089-1926
US

V. Phone/Fax

Practice location:
  • Phone: 847-541-0199
  • Fax: 847-808-9772
Mailing address:
  • Phone: 847-353-1500
  • Fax: 847-465-1964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number08005
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. SHANAN EGGER
Title or Position: CFO
Credential:
Phone: 847-353-1762