NPIMap

Organization Active NPI

Omni Youth Services, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Buffalo Grove, IL
National Provider Identifier
1124401179
Registry record updated Jan 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
OMNI YOUTH SERVICES, INC.
Practice address
1111 W Lake Cook Rd
Buffalo Grove, IL 60689
Phone
(847) 353-1500
Fax
(847) 465-1964
NPI assigned
Jul 8, 2015
Organization subpart
Yes
Parent organization
OMNI YOUTH SERVICES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 8, 2026

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

Authorized official

Name
Mr. Shanan Matthew Egger, CFO
Title
Cfo
Phone
(847) 353-1762

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary
Adult Mental Health Clinic/Center 261QM0850X
Adolescent and Children Mental Health Clinic/Center 261QM0855X

Addresses

Primary practice location

1111 W Lake Cook Rd
Buffalo Grove, IL 60689

Mailing address

1111 W Lake Cook Rd
Buffalo Grove, IL 60689
Phone (847) 353-1500

Other practice location 1

1880 W Winchester Rd Ste 108
Libertyville, IL 60048-5321
Phone (224) 676-2317

Other names 1

  • EDGE Counseling Solutions Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160425000917 IL Part B Supplier - Clinic/Group Practice 3678872702 Receives reassigned benefits from 8 practitioners
Practice locations: Buffalo Grove, IL; Libertyville, IL

National Provider Directory

National Provider Directory
Tax ID family
Omni Youth Services Inc11 organizations share this tax ID, including this one
Part of
Omni Youth Services Inc

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1111 W Lake Cook Rd
Buffalo Grove, IL 60089
Phone (847) 353-1500

180 N Michigan Ave
Ste 505
Chicago, IL 60601
Phone (224) 676-2317

1880 W Winchester Rd
Ste 108
Libertyville, IL 60048
Phone (224) 676-2317

1860 W Winchester Rd
Ste 101
Libertyville, IL 60048
Phone (224) 676-2317

Ownership & related parties

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.

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1436313600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767830400000",
    "number": "1124401179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 W LAKE COOK RD",
            "city": "BUFFALO GROVE",
            "state": "IL",
            "postal_code": "60689",
            "telephone_number": "847-353-1500",
            "fax_number": "847-465-1964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 W LAKE COOK RD",
            "city": "BUFFALO GROVE",
            "state": "IL",
            "postal_code": "60689",
            "telephone_number": "847-353-1500",
            "fax_number": "847-465-1964"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1880 W Winchester Rd Ste 108",
            "address_purpose": "LOCATION",
            "city": "Libertyville",
            "state": "IL",
            "postal_code": "600485321",
            "country_code": "US",
            "telephone_number": "224-676-2317",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OMNI YOUTH SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OMNI YOUTH SERVICES, INC.",
        "enumeration_date": "2015-07-08",
        "last_updated": "2026-01-08",
        "certification_date": "2026-01-08",
        "status": "A",
        "authorized_official_last_name": "EGGER",
        "authorized_official_first_name": "SHANAN",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "847-353-1762",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CFO"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EDGE Counseling Solutions",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "EDGE Counseling Solutions",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Buffalo Grove, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.