MEDICARE: ADA S. MCKINLEY COMMUNITY SERVICES, INC.

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility		IL
2	315P00000X	Intellectual Disabilities Intermediate Care Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0030585	OTHER	IL	IDPH LICENSE

General Provider Information

NPI Number	:	1538411764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADA S. MCKINLEY COMMUNITY SERVICES, INC.

Provider Business Mailing Address
First Line	:	1359 W WASHINGTON BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-1905
Country	:	US
Telephone Number	:	312-385-2000
Fax Number	:	312-554-0292

Provider Business Practice Location Address
First Line	:	4237 S INDIANA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-3213
Country	:	US
Telephone Number	:	773-373-1044
Fax Number	:	773-373-2387

Authorized Official
Title or Position	:	DIR QA&C
Name	:	KEN FRIES
Credential	:
Telephone Number	:	630-744-9431

Provider Enumeration Date	:	10/11/2012
Last Update Date	:	05/06/2025

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