NPIMap

Organization Active NPI

Independence Health & Therapy

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Woodstock, IL
National Provider Identifier
1598717597
Registry record updated Apr 27, 2023
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
INDEPENDENCE HEALTH & THERAPY
Practice address
2028 N Seminary Ave
Woodstock, IL 60098-2626
Phone
(815) 338-3590
Fax
(815) 337-4406
NPI assigned
May 17, 2006
Last updated
Apr 27, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2023

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

Authorized official

Name
Mary Fisher
Title
Finance Director
Phone
(815) 338-3590

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Day Care Clinic/Center 261QA0600X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X IL Primary

Addresses

Primary practice location

2028 N Seminary Ave
Woodstock, IL 60098-2626

Mailing address

2028 N Seminary Ave
Woodstock, IL 60098-2626
Phone (815) 338-3590

Other names 1

  • Family Alliance Inc Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040129000421 IL Part B Supplier - Clinic/Group Practice 2062315849 Receives reassigned benefits from 11 practitioners
2 other NPIs on this enrollment
Practice locations: Woodstock, IL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2011904Independence Health & Therapy2028 N Seminary Ave, Woodstock, IL 60098Certificate of waiverAug 23, 2026

National Provider Directory

National Provider Directory
Tax ID family
Family Alliance Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Practitioners & affiliated clinicians

Practitioners 11

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": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682553600000",
    "number": "1598717597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2028 N SEMINARY AVE",
            "city": "WOODSTOCK",
            "state": "IL",
            "postal_code": "600982626",
            "telephone_number": "815-338-3590",
            "fax_number": "815-337-4406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2028 N SEMINARY AVE",
            "city": "WOODSTOCK",
            "state": "IL",
            "postal_code": "600982626",
            "telephone_number": "815-338-3590",
            "fax_number": "815-337-4406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENCE HEALTH & THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2023-04-27",
        "certification_date": "2023-04-27",
        "status": "A",
        "authorized_official_last_name": "FISHER",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "FINANCE DIRECTOR",
        "authorized_official_telephone_number": "815-338-3590"
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Alliance Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Family Alliance Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Woodstock, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.