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General NPI Number Information
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NPI Number | 1932654845
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Entity Type | Organization
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Legal Business Name | THE THRESHOLDS
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Dates
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Enumeration Date | 08/20/2016
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Last Update Date | 08/20/2016
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Provider Practice Location Address
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Address Line | 6815 W CAPITOL DR # 305
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City | MILWAUKEE
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State | WI
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Zip | 53216-2070
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Country | US
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Telephone | 773-572-5147
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Fax |
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Provider Business Mailing Address
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Address Line | 4101 N RAVENSWOOD AVE
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City | CHICAGO
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State | IL
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Zip | 60613-2193
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Country | US
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Telephone | 773-572-5500
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARK ISHAUG
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Credential |
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Telephone | 773-572-5500
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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 | 04133
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License Number State | IL
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