Organization Active NPI

Nicasa

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Round Lake, IL
National Provider Identifier
1457573099
Registry record updated Apr 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
NICASA
Practice address
31979 N Fish Lkae Rd
Round Lake, IL 60073
Phone
(847) 546-6450
Fax
(847) 546-6760
NPI assigned
May 3, 2007
Last updated
Apr 6, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2021

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

Authorized official

Name
Mr. Bruce Johnson
Title
Coo
Phone
(847) 546-6450

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X CA06140005A IL
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

31979 N Fish Lkae Rd
Round Lake, IL 60073

Mailing address

31979 N Fish Lkae Rd
Round Lake, IL 60073
Phone (847) 546-6450

National Provider Directory

National Provider Directory
Tax ID family
Nicasa NFP13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617667200000",
    "number": "1457573099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31979 N FISH LKAE RD",
            "city": "ROUND LAKE",
            "state": "IL",
            "postal_code": "60073",
            "telephone_number": "847-546-6450",
            "fax_number": "847-546-6760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31979 N FISH LKAE RD",
            "city": "ROUND LAKE",
            "state": "IL",
            "postal_code": "60073",
            "telephone_number": "847-546-6450",
            "fax_number": "847-546-6760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICASA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2021-04-06",
        "certification_date": "2021-04-06",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "847-546-6450",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "IL",
            "license": "CA06140005A",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Round Lake, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 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.

Verify at the official NPI Registry.