NPIMap

Organization Active NPI

Independence Center

  • Mental Illness Community Based Residential Treatment Facility
  • Waukegan, IL
National Provider Identifier
1336318153
Registry record updated Aug 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
INDEPENDENCE CENTER
Practice address
1730 Washington St
Waukegan, IL 60085-5102
Phone
(847) 360-1020
NPI assigned
Feb 26, 2008
Reactivated
Aug 3, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2011

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

Authorized official

Name
Michael Pierce
Title
Executive Director
Phone
(847) 244-4442

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Community/Behavioral Health Agency 251S00000X
Mental Illness Community Based Residential Treatment Facility 320800000X Primary

Addresses

Primary practice location

1730 Washington St
Waukegan, IL 60085-5102

Mailing address

2025 Washington St
Waukegan, IL 60085-5131

National Provider Directory

National Provider Directory
Tax ID family
Independence Center8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1203984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312329600000",
    "number": "1336318153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2025 WASHINGTON ST",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600855131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1730 WASHINGTON ST",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600855102",
            "telephone_number": "847-360-1020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENCE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-26",
        "last_updated": "2011-08-03",
        "deactivation_date": "2008-03-31",
        "reactivation_date": "2011-08-03",
        "status": "A",
        "authorized_official_last_name": "PIERCE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "847-244-4442"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukegan, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2011; 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.