=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710775044
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RADIUS FOUNDATION, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2025
-----------------------------------------------------
Last Update Date | 04/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1014 MAIN ST
-----------------------------------------------------
City | CRETE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60417-1911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-847-1002
-----------------------------------------------------
Fax | 708-847-1004
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11952 S HARLEM AVE STE 100
-----------------------------------------------------
City | PALOS HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60463-1386
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-923-0800
-----------------------------------------------------
Fax | 708-923-0800
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | WILLIAM J BRAMLETT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 773-507-4695
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QM2800X
-----------------------------------------------------
Taxonomy Name | Methadone Clinic
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------