MEDICARE: TRILOGY, INC.

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1912383720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRILOGY, INC.

Provider Business Mailing Address
First Line	:	1400 W GREENLEAF AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-2805
Country	:	US
Telephone Number	:	773-508-6100
Fax Number	:	773-262-4841

Provider Business Practice Location Address
First Line	:	1859 S PULASKI RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-2847
Country	:	US
Telephone Number	:	773-508-6100
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. JOHN MAYES
Credential	:
Telephone Number	:	773-508-6100

Provider Enumeration Date	:	08/04/2015
Last Update Date	:	12/01/2016

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Directions to “TRILOGY, INC. ” Practice Location

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