MEDICARE: THRESHOLDS

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	04133	IL
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1528361177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRESHOLDS

Provider Business Mailing Address
First Line	:	4101 N RAVENSWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613
Country	:	US
Telephone Number	:	773-572-5500
Fax Number	:	773-271-2597

Provider Business Practice Location Address
First Line	:	6710 N SHERIDAN RD APT 206
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-4542
Country	:	US
Telephone Number	:	773-572-5500
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MR. AL SHOREIBAH
Credential	:
Telephone Number	:	773-572-5262

Provider Enumeration Date	:	12/20/2010
Last Update Date	:	01/17/2019

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