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General NPI Number Information
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NPI Number | 1922411008
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Entity Type | Organization
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Legal Business Name | YOUTH OUTREACH SERVICES
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Dates
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Enumeration Date | 06/06/2014
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 5910 W DIVISION ST
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City | CHICAGO
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State | IL
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Zip | 60651-1031
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Country | US
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Telephone | 773-777-7112
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Fax |
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Provider Business Mailing Address
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Address Line | 2411 W CONGRESS PKWY
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City | CHICAGO
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State | IL
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Zip | 60612-3534
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Country | US
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Telephone | 773-777-7112
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JAMIE NOTO
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Credential |
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Telephone | 773-205-0474
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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 | A-0534-0005-A
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License Number State | IL
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