MEDICARE: HUMAN RESOURCES DEVELOPMENT INSTITUTE, INC-ESSENCE HOUSE

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	324500000X	Substance Abuse Rehabilitation Facility	A-0180-0019-A	IL

General Provider Information

NPI Number	:	1851766430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUMAN RESOURCES DEVELOPMENT INSTITUTE, INC-ESSENCE HOUSE

Provider Business Mailing Address
First Line	:	222 S JEFFERSON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60661-5603
Country	:	US
Telephone Number	:	312-441-9009
Fax Number	:	312-441-9019

Provider Business Practice Location Address
First Line	:	1223 W MARQUETTE RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60636-2926
Country	:	US
Telephone Number	:	773-651-2720
Fax Number	:	773-651-2721

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	JOEL K. JOHNSON
Credential	:
Telephone Number	:	312-441-9009

Provider Enumeration Date	:	12/08/2015
Last Update Date	:	12/08/2015

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