MEDICARE: FOUNDATIONS CHICAGO, LLC

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	A89410001A	IL

General Provider Information

NPI Number	:	1386197481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNDATIONS CHICAGO, LLC

Provider Business Mailing Address
First Line	:	1000 HEALTH PARK DRIVE
Second Line	:	BUIDLING THREE, SUITE 400
City	:	BRENTWOOD
State	:	TN
Zip	:	37027
Country	:	US
Telephone Number	:	615-386-7255
Fax Number	:	615-645-7445

Provider Business Practice Location Address
First Line	:	225 W WASHINGTON ST
Second Line	:	SECOND FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60606-2418
Country	:	US
Telephone Number	:	855-317-8259
Fax Number	:

Authorized Official
Title or Position	:	EVP-CHIEF FINANCIAL OFFICER
Name	:	STEVE FILTON
Credential	:
Telephone Number	:	610-382-3319

Provider Enumeration Date	:	07/26/2016
Last Update Date	:	05/20/2019

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