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
1	251S00000X	Community/Behavioral Health Agency	04006	IL

General Provider Information

NPI Number	:	1336369529
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LESTER AND ROSALIE ANIXTER CENTER

Provider Business Mailing Address
First Line	:	6610 N. CLARK STREET
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626
Country	:	US
Telephone Number	:	773-761-1501
Fax Number	:	773-977-1240

Provider Business Practice Location Address
First Line	:	6508 N BOSWORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-4911
Country	:	US
Telephone Number	:	847-675-3200
Fax Number	:	847-675-3274

Authorized Official
Title or Position	:	SENIOR DIRECTOR OF FINANCE
Name	:	MARY DESMOND
Credential	:
Telephone Number	:	773-761-1501

Provider Enumeration Date	:	04/27/2007
Last Update Date	:	01/12/2016

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