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General NPI Number Information
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NPI Number | 1144763269
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Entity Type | Organization
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Legal Business Name | ERC INSIGHT
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Dates
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Enumeration Date | 11/21/2016
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Last Update Date | 11/21/2016
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Provider Practice Location Address
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Address Line | 200 E OHIO ST
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City | CHICAGO
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State | IL
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Zip | 60611-7269
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Country | US
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Telephone | 773-572-8386
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Fax |
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Provider Business Mailing Address
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Address Line | 421 W BARRY AVE APT 203
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City | CHICAGO
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State | IL
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Zip | 60657-5545
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Country | US
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Telephone | 773-383-4817
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | EDEN NEWMARK
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Credential | LCSW
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Telephone | 773-383-4817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | 149.017861
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License Number State | IL
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