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General NPI Number Information
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NPI Number | 1124988480
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Entity Type | Organization
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Legal Business Name | HENDRICKSON HOUSE OF SOBRIETY LLC
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Dates
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Enumeration Date | 11/17/2025
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Last Update Date | 11/17/2025
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Provider Practice Location Address
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Address Line | 2901 S 49TH AVE
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City | CICERO
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State | IL
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Zip | 60804-3634
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Country | US
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Telephone | 464-927-9879
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Fax |
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Provider Business Mailing Address
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Address Line | 4949 N NORMANDY AVE
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City | CHICAGO
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State | IL
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Zip | 60656-4001
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEVE HENDRICKSON
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Credential |
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Telephone | 612-685-4958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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