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General NPI Number Information
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NPI Number | 1376680512
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Entity Type | Organization
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Legal Business Name | CARITAS
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 02/12/2021
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Provider Practice Location Address
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Address Line | 140 NORTH ASHLAND AVENUE
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City | CHICAGO
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State | IL
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Zip | 60607
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Country | US
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Telephone | 312-850-9411
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Fax | 312-850-3288
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Provider Business Mailing Address
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Address Line | 1301 WEST 22ND STREET SUITE 500
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City | OAK BROOK
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State | IL
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Zip | 60523
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Country | US
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Telephone | 630-572-0556
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Fax | 630-572-0566
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | JESSECA WATSON
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Credential |
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Telephone | 630-572-8228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number |
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License Number State |
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