Ids Group Roselle Inc

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

31870006 Issued in IL

Legal business name

IDS GROUP ROSELLE INC

Practice address

644 E Irving Park Rd
Roselle, IL 60172-2303

Phone

(847) 668-8969

Fax

(630) 893-8477

NPI assigned

Feb 9, 2017

Organization subpart

No

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

Authorized official

Name

Mr. David C Ideran, LCPC

Title

President

Phone

(847) 668-8969

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1486598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486598400000",
    "number": "1437697455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "644 E IRVING PARK RD",
            "city": "ROSELLE",
            "state": "IL",
            "postal_code": "601722303",
            "telephone_number": "847-668-8969",
            "fax_number": "630-893-8477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "644 E IRVING PARK RD",
            "city": "ROSELLE",
            "state": "IL",
            "postal_code": "601722303",
            "telephone_number": "847-668-8969",
            "fax_number": "630-893-8477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDS GROUP ROSELLE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-09",
        "last_updated": "2017-02-09",
        "status": "A",
        "authorized_official_last_name": "IDERAN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-668-8969",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "IL",
            "license": "31870006",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Ho, PHARMD
• Zoey Marie Hornstein, LSW, CADC
• Noor Fatima Husain, M.D.
• Atha Ali Hyderi, O.D
• Hassan Souhail Ibrahim Sadik, DDS
• Sandra Lynn Jacobi, RBT
• Jay P. Mueller D.D.S.
• Jeanette Bond Speech Language Cognitive Therapy LLC
• James Johnson, D.C.
• Katelyn J Johnson, MA

• Community/Behavioral Health Agency in Roselle, IL
• Providers in Roselle, IL by specialty
• Community/Behavioral Health Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2017; 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.