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NPI Code Detail

MEDICARE: LESTER AND ROSALIE ANIXTER CENTER

MEDICARE: LESTER AND ROSALIE ANIXTER CENTER
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
1261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number : 1306066626
Entity Type Code : Organization
Provider Name (Legal Business Name) : LESTER AND ROSALIE ANIXTER CENTER
Provider Business Mailing Address
First Line : 6610 N CLARK ST
Second Line : FIRST FLOOR OFFICE
City : CHICAGO
State : IL
Zip : 60626-4062
Country : US
Telephone Number : 773-761-1501
Fax Number :
Provider Business Practice Location Address
First Line : 6610 N CLARK ST
Second Line : FIRST FLOOR OFFICE
City : CHICAGO
State : IL
Zip : 60626-4062
Country : US
Telephone Number : 773-761-1501
Fax Number :
Authorized Official
Title or Position : CLAIMS ANALYST
Name : HEIDI OLKOWSKI
Credential :
Telephone Number : 773-697-6529
Provider Enumeration Date : 04/27/2007
Last Update Date : 04/28/2021

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Directions to “LESTER AND ROSALIE ANIXTER CENTER ” Practice Location

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