MEDICARE: REASSEMBLE EDUCATION & SUPPORT TRAINING, NFP

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
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
2	276400000X	Substance Use Disorder Rehabilitation Hospital Unit

General Provider Information

NPI Number	:	1235090416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REASSEMBLE EDUCATION & SUPPORT TRAINING, NFP

Provider Business Mailing Address
First Line	:	8721 S STATE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60619-6608
Country	:	US
Telephone Number	:	773-488-9770
Fax Number	:

Provider Business Practice Location Address
First Line	:	8721 S STATE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60619-6608
Country	:	US
Telephone Number	:	773-488-9770
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	LADONNA TAYLOR
Credential	:
Telephone Number	:	708-552-6989

Provider Enumeration Date	:	11/18/2025
Last Update Date	:	04/07/2026

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