MEDICARE: LESTER & ROSALIE ANIXTER 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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689150161
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LESTER & ROSALIE ANIXTER CENTER

Provider Business Mailing Address
First Line	:	6610 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-4062
Country	:	US
Telephone Number	:	773-761-1501
Fax Number	:	773-274-3523

Provider Business Practice Location Address
First Line	:	6125 S KENWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-2818
Country	:	US
Telephone Number	:	773-752-6000
Fax Number	:	773-274-3523

Authorized Official
Title or Position	:	DIRECTOR OF FINANCE
Name	:	MARY DESMOND
Credential	:
Telephone Number	:	773-761-1501

Provider Enumeration Date	:	07/17/2018
Last Update Date	:	07/17/2018

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Directions to “LESTER & ROSALIE ANIXTER CENTER ” Practice Location

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