MEDICARE: ABOVE & BEYOND FAMILY RECOVERY 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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1497109284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABOVE & BEYOND FAMILY RECOVERY CENTER

Provider Business Mailing Address
First Line	:	2942 W LAKE ST.
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612
Country	:	US
Telephone Number	:	773-940-2960
Fax Number	:	773-940-2996

Provider Business Practice Location Address
First Line	:	2942 W LAKE ST.
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612
Country	:	US
Telephone Number	:	773-940-2960
Fax Number	:	773-940-2996

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DAN HOSTETLER
Credential	:
Telephone Number	:	773-940-2960

Provider Enumeration Date	:	04/18/2016
Last Update Date	:	01/31/2024

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