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General NPI Number Information
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NPI Number | 1023434917
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Entity Type | Organization
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Legal Business Name | ACCESS BEHAVIORAL SERVICES
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Dates
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Enumeration Date | 03/15/2014
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Last Update Date | 03/15/2014
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Provider Practice Location Address
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Address Line | 3948 W 26TH ST SUITE 114
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City | CHICAGO
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State | IL
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Zip | 60623-3738
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Country | US
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Telephone | 773-522-5460
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Fax | 773-522-5465
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Provider Business Mailing Address
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Address Line | 3948 W 26TH ST SUITE 114
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City | CHICAGO
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State | IL
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Zip | 60623-3738
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Country | US
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Telephone | 773-522-5460
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Fax | 773-522-5465
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | ERNESTINA ONTIVEROS
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Credential | MA
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Telephone | 773-522-5460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | A-8712-0001-A
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | A-8712-0001-A
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License Number State | IL
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