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General NPI Number Information
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NPI Number | 1811133671
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Entity Type | Organization
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Legal Business Name | NORTH SHORE ADOLESCENT RECOVERY CENTER
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Dates
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Enumeration Date | 12/29/2008
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Last Update Date | 08/16/2010
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Provider Practice Location Address
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Address Line | 211 WAUKEGAN RD SUITE 100
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City | NORTHFIELD
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State | IL
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Zip | 60093-2757
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Country | US
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Telephone | 847-446-2270
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Fax | 847-446-2172
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Provider Business Mailing Address
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Address Line | 211 WAUKEGAN RD SUITE 100
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City | NORTHFIELD
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State | IL
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Zip | 60093-2757
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Country | US
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Telephone | 847-446-2270
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Fax | 847-446-2172
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. KIMBERLY EDWARDS EVEN
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Credential |
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Telephone | 847-446-2270
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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-5256-0001-A
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License Number State | IL
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