Active NPI
Caritas
- Methadone Clinic
- Chicago, IL
National Provider Identifier
1376680512
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Methadone Clinic
- Legal business name
- CARITAS
- Practice address
- 140 North Ashland Avenue
Chicago, IL 60607 - Phone
- (312) 850-9411
- Fax
- (312) 850-3288
- NPI assigned
- Jan 30, 2007
- Organization subpart
- Yes
- Parent organization
- CARITAS
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jesseca Watson
- Title
- Credentialing Manager
- Phone
- (630) 572-8228
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Methadone Clinic | 261QM2800X | Primary | ||
| Substance Use Disorder Rehabilitation Clinic/Center | 261QR0405X |
Addresses
Primary practice location
140 North Ashland Avenue
Chicago, IL 60607
Mailing address
1301 West 22ND Street
Suite 500
Oak Brook, IL 60523
Phone (630) 572-0556
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| A-0554-0001-A | Other | IL | ILLINOIS DEPARTMENT OF HUMAN SERVICES - SUPR |
| 023 | Medicaid | IL |
Other names 1
- Caritas Central Intake
National Provider Directory
National Provider Directory- Part of
- Caritas
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170115200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1613088000000",
"number": "1376680512",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1301 WEST 22ND STREET",
"address_2": "SUITE 500",
"city": "OAK BROOK",
"state": "IL",
"postal_code": "60523",
"telephone_number": "630-572-0556",
"fax_number": "630-572-0566"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "140 NORTH ASHLAND AVENUE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60607",
"telephone_number": "312-850-9411",
"fax_number": "312-850-3288"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CARITAS",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "CARITAS",
"enumeration_date": "2007-01-30",
"last_updated": "2021-02-12",
"certification_date": "2021-02-12",
"status": "A",
"authorized_official_last_name": "WATSON",
"authorized_official_first_name": "JESSECA",
"authorized_official_title_or_position": "CREDENTIALING MANAGER",
"authorized_official_telephone_number": "630-572-8228"
},
"taxonomies": [
{
"code": "261QM2800X",
"taxonomy_group": "",
"desc": "Clinic/Center, Methadone",
"state": null,
"license": null,
"primary": true
},
{
"code": "261QR0405X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ILLINOIS DEPARTMENT OF HUMAN SERVICES - SUPR",
"identifier": "A-0554-0001-A",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "023",
"state": "IL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Caritas Central Intake",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.