MEDICARE: THE YOUTH CAMPUS

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	253J00000X	Foster Care Agency	141828	IL

General Provider Information

NPI Number	:	1497073241
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE YOUTH CAMPUS

Provider Business Mailing Address
First Line	:	733 N PROSPECT AVE
Second Line	:
City	:	PARK RIDGE
State	:	IL
Zip	:	60068-2764
Country	:	US
Telephone Number	:	847-823-5161
Fax Number	:	847-823-9291

Provider Business Practice Location Address
First Line	:	901 W JACKSON BLVD
Second Line	:	5TH FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60607-3023
Country	:	US
Telephone Number	:	312-243-0533
Fax Number	:	312-243-7610

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	DR. JAMES J. GUIDI
Credential	:	PSY.D., CADC
Telephone Number	:	847-823-5161

Provider Enumeration Date	:	05/04/2010
Last Update Date	:	05/04/2010

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Directions to “THE YOUTH CAMPUS ” Practice Location

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