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NPI Code Detail

MEDICARE: LESTER & ROSALIE ANIXTER CENTER

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
1261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center

Other Identifiers

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

General Provider Information

NPI Number : 1730653247
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 : 8001 S WESTERN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60620-5930
Country : US
Telephone Number : 773-761-1501
Fax Number : 773-274-3523
Authorized Official
Title or Position : CLAIMS SPECIALIST
Name : HEIDI OLKOWSKI
Credential :
Telephone Number : 773-761-1501
Provider Enumeration Date : 01/17/2019
Last Update Date : 01/17/2019

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Directions to “LESTER & ROSALIE ANIXTER CENTER ” Practice Location

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