Alexian Brothers Behavioral Health Hospital

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

ALEXIAN BROTHERS BEHAVIORAL HEALTH HOSPITAL

Practice address

801 Gloucester Dr
Elk Grove Village, IL 60007-3319

Phone

(847) 981-5900

NPI assigned

Jan 20, 2023

Organization subpart

Yes

Parent organization

ALEXIAN BROTHERS BEHAVIORAL HEALTH HOSPITALAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mary Jo Mackniskas

Title

Sr. Director, Net Revenue and Reimb

Phone

(773) 213-0776

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Foglia Residential Treatment Center Other name

Part of

Alexian Bro Behavioral Hosp

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Alexian Brothers Behavioral Health Hospital

  • Psychiatric Hospital
  • Hoffman Estates, IL
  • NPI 1013017839
  NPPES parent name

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kyle Patrick Gomez

  • Clinical Social Worker
  • Hoffman Estates, IL
  • NPI 1790576254
  NPD
• Colleen Nolan, LPC, CADC

  • Counselor
  • Elk Grove Village, IL
  • NPI 1962986653
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1674172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674172800000",
    "number": "1023723392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 MOON LAKE BLVD",
            "city": "HOFFMAN ESTATES",
            "state": "IL",
            "postal_code": "601691010",
            "telephone_number": "773-213-0776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 GLOUCESTER DR",
            "city": "ELK GROVE VILLAGE",
            "state": "IL",
            "postal_code": "600073319",
            "telephone_number": "847-981-5900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALEXIAN BROTHERS BEHAVIORAL HEALTH HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ALEXIAN BROTHERS BEHAVIORAL HEALTH HOSPITAL",
        "enumeration_date": "2023-01-20",
        "last_updated": "2023-01-20",
        "certification_date": "2023-01-11",
        "status": "A",
        "authorized_official_last_name": "MACKNISKAS",
        "authorized_official_first_name": "MARY JO",
        "authorized_official_title_or_position": "SR. DIRECTOR, NET REVENUE AND REIMB",
        "authorized_official_telephone_number": "773-213-0776"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUPR LICENSE",
            "identifier": "A-9905-0003-A",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Foglia Residential Treatment Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Shaista Ahmed
• Lubna Ahsan, PHARMD
• Alex B Lipowich MD SC
• Titus Alex
• Bonita S Alexander, MD
• Alexian Brothers Medical Care Group NFP (Suburban Lung)
• Alexian Brothers Medical Center
• Alexian Brothers Medical Center
• Alexian Brothers Medical Center
• Alexian Brothers Medical Center

• Substance Abuse Rehabilitation Facility in Elk Grove Village, IL
• Providers in Elk Grove Village, IL by specialty
• Substance Abuse Rehabilitation Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.