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NPI Code Detail

MEDICARE: ICG SERVICES, LLC

MEDICARE: ICG SERVICES, LLC
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
1261QM0850XAdult Mental Health Clinic/Center
2261QM0855XAdolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number : 1659090827
Entity Type Code : Organization
Provider Name (Legal Business Name) : ICG SERVICES, LLC
Provider Business Mailing Address
First Line : 8700 S DANTE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60619-7118
Country : US
Telephone Number : 833-717-4244
Fax Number : 773-346-7260
Provider Business Practice Location Address
First Line : 8700 S DANTE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60619-7118
Country : US
Telephone Number : 773-347-9075
Fax Number : 312-924-0669
Authorized Official
Title or Position : CEO
Name : JASMINE C BANKHEAD
Credential :
Telephone Number : 773-606-8002
Provider Enumeration Date : 08/23/2022
Last Update Date : 03/13/2026

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Directions to “ICG SERVICES, LLC ” Practice Location

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