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NPI Code Detail

MEDICARE: BOBBY E. WRIGHT COMPREHENSIVE BEHAVIORAL HEALTH CENTER, INC.

MEDICARE: BOBBY E. WRIGHT COMPREHENSIVE BEHAVIORAL HEALTH CENTER, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor002520001IL
2101YM0800XMental Health Counselor002520001IL
3103TM1800XIntellectual & Developmental Disabilities Psychologist002520001IL
4251S00000XCommunity/Behavioral Health Agency
5261QM2800XMethadone Clinic
6261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center
7276400000XSubstance Use Disorder Rehabilitation Hospital Unit
8324500000XSubstance Abuse Rehabilitation Facility
93245S0500XChildren's Substance Abuse Rehabilitation Facility
10261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1164475018
Entity Type Code : Organization
Provider Name (Legal Business Name) : BOBBY E. WRIGHT COMPREHENSIVE BEHAVIORAL HEALTH CENTER, INC.
Provider Business Mailing Address
First Line : 5002 W MADISON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60644-4127
Country : US
Telephone Number : 773-722-7900
Fax Number : 773-638-6774
Provider Business Practice Location Address
First Line : 5002 W MADISON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60644-4127
Country : US
Telephone Number : 773-722-7900
Fax Number : 773-638-6774
Authorized Official
Title or Position : DIRECTOR OF COMPLIANCE
Name : TAKASHA MCINTOSH
Credential :
Telephone Number : 773-722-7900
Provider Enumeration Date : 05/19/2006
Last Update Date : 04/16/2024

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