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General NPI Number Information
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NPI Number | 1609557735
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Entity Type | Organization
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Legal Business Name | OMNI YOUTH SERVICES
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Dates
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Enumeration Date | 07/31/2023
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Last Update Date | 07/31/2023
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Provider Practice Location Address
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Address Line | 1880 W WINCHESTER RD STE 108
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-5321
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Country | US
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Telephone | 224-676-2317
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Fax | 847-353-1759
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Provider Business Mailing Address
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Address Line | 1111 W LAKE COOK RD
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City | BUFFALO GROVE
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State | IL
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Zip | 60089-1926
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Country | US
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Telephone | 847-353-1758
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Fax | 847-353-1759
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Authorized Official
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Title or Position | PRESIDENT
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Name | DORYCE MCCARTHY
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Credential | LCSW
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Telephone | 847-353-1758
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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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