=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316827645
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NISSA FOUNDATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2025
-----------------------------------------------------
Last Update Date | 01/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8170 MCCORMICK BLVD STE 107
-----------------------------------------------------
City | SKOKIE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60076-2914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-213-0239
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8170 MCCORMICK BLVD STE 107
-----------------------------------------------------
City | SKOKIE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60076-2914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-213-0239
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | AVIVA VILENSKI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 773-216-2904
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------