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General NPI Number Information
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NPI Number | 1457933897
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Entity Type | Organization
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Legal Business Name | CRC INSTITUTE, LLC
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Dates
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Enumeration Date | 04/26/2021
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Last Update Date | 10/21/2021
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Provider Practice Location Address
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Address Line | 2350 NORTH LINCOLN AVE FLOOR 5
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City | CHICAGO
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State | IL
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Zip | 60614
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Country | US
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Telephone | 630-291-0795
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Fax |
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Provider Business Mailing Address
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Address Line | 2350 NORTH LINCOLN AVE FLOOR 5
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City | CHICAGO
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State | IL
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Zip | 60614
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Country | US
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Telephone | 630-291-0795
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Fax |
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Authorized Official
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Title or Position | CHIEF ADMINISTRATIVE OFFICER
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Name | AMY EIMERMAN
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Credential |
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Telephone | 630-291-0795
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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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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 163WI0500X
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Taxonomy Name | Infusion Therapy Registered Nurse
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #5
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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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