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General NPI Number Information
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NPI Number | 1497073241
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Entity Type | Organization
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Legal Business Name | THE YOUTH CAMPUS
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Dates
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Enumeration Date | 05/04/2010
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Last Update Date | 05/04/2010
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Provider Practice Location Address
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Address Line | 901 W JACKSON BLVD 5TH FLOOR
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City | CHICAGO
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State | IL
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Zip | 60607-3023
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Country | US
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Telephone | 312-243-0533
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Fax | 312-243-7610
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Provider Business Mailing Address
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Address Line | 733 N PROSPECT AVE
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City | PARK RIDGE
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State | IL
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Zip | 60068-2764
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Country | US
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Telephone | 847-823-5161
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Fax | 847-823-9291
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. JAMES J. GUIDI
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Credential | PSY.D., CADC
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Telephone | 847-823-5161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number | 141828
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License Number State | IL
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