MEDICARE: THE CAREPORT, 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
1	261QM0850X	Adult Mental Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1568810778	OTHER	IL	STATE OF IL

General Provider Information

NPI Number	:	1811572241
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CAREPORT, LLC

Provider Business Mailing Address
First Line	:	101 W GRAND AVE STE 402
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-7129
Country	:	US
Telephone Number	:	773-879-8395
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 W GRAND AVE STE 402
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-7129
Country	:	US
Telephone Number	:	773-879-8395
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MEAGAN BROWN
Credential	:	LCSE
Telephone Number	:	773-879-8395

Provider Enumeration Date	:	03/17/2021
Last Update Date	:	03/17/2021

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Directions to “THE CAREPORT, LLC ” Practice Location

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