MEDICARE: METHODIST YOUTH 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	251K00000X	Public Health or Welfare Agency	206725-05	IL

General Provider Information

NPI Number	:	1568430205
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METHODIST YOUTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	954 W WASHINGTON BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-2224
Country	:	US
Telephone Number	:	312-733-8810
Fax Number	:	312-733-8903

Provider Business Practice Location Address
First Line	:	954 W WASHINGTON BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-2224
Country	:	US
Telephone Number	:	312-733-8810
Fax Number	:	312-733-8903

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MS. CYNTHIA JURISHICA
Credential	:
Telephone Number	:	312-733-8810

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	08/22/2020

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