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General NPI Number Information
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NPI Number | 1730472275
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Entity Type | Organization
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Legal Business Name | WAY BACK INN
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Dates
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Enumeration Date | 05/17/2011
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 104 OAK ST.
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City | MAYWOOD
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State | IL
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Zip | 60153
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Country | US
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Telephone | 708-344-3301
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Fax | 708-344-2944
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Provider Business Mailing Address
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Address Line | 104 OAK ST.
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City | MAYWOOD
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State | IL
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Zip | 60153
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Country | US
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Telephone | 708-344-3301
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Fax | 708-344-2944
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. ANITA MARIA PINDIUR
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Credential | MS, LCPC
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Telephone | 708-344-3301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | A-0388-0008-A
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | A-0388-0011-A
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | A-0388-0002-A
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | A-0388-0010-A
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | A-0388-0004-A
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License Number State | IL
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Taxonomy #6
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | A-0388-0009-A
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License Number State | IL
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Taxonomy #7
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | A-0388-0007-A
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License Number State | IL
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Taxonomy #8
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | A-0388-0008-A
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License Number State | IL
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Taxonomy #9
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | A-0388-0001-A
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License Number State | IL
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Taxonomy #10
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | A-0388-0004-A
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License Number State | IL
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Taxonomy #11
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | A-0388-0010-A
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License Number State | IL
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Taxonomy #12
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | A-0388-0011-A
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License Number State | IL
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Taxonomy #13
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | A-0388-0002-A
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License Number State | IL
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Taxonomy #14
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | A-0388-0009-A
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License Number State | IL
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