Organization Active NPI

Nicasa, NFP

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Waukegan, IL
National Provider Identifier
1700336229
Registry record updated Apr 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
14012 Issued in IL
Legal business name
NICASA, NFP
Practice address
1113 W Greenwood Ave
Waukegan, IL 60087-4908
Phone
(847) 244-4434
Fax
(847) 244-4098
NPI assigned
Oct 7, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2021

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

Authorized official

Name
Linda Snelten
Title
Chief Operating Officer
Phone
(847) 546-6450

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 14012 IL Primary

Addresses

Primary practice location

1113 W Greenwood Ave
Waukegan, IL 60087-4908

Mailing address

31979 N Fish Lake Rd
Round Lake, IL 60073-9517
Phone (814) 546-6450

Other identifiers 1

IdentifierTypeStateIssuer
14012OtherILILLINOIS DEPT OF HUMAN SERVICES

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.

NPI Registry JSON

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

{
    "created_epoch": "1475798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617753600000",
    "number": "1700336229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31979 N FISH LAKE RD",
            "city": "ROUND LAKE",
            "state": "IL",
            "postal_code": "600739517",
            "telephone_number": "814-546-6450",
            "fax_number": "847-546-6760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1113 W GREENWOOD AVE",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600874908",
            "telephone_number": "847-244-4434",
            "fax_number": "847-244-4098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICASA, NFP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-07",
        "last_updated": "2021-04-07",
        "certification_date": "2021-04-07",
        "status": "A",
        "authorized_official_last_name": "SNELTEN",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "847-546-6450"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "IL",
            "license": "14012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ILLINOIS DEPT OF HUMAN SERVICES",
            "identifier": "14012",
            "state": "IL"
        }
    ],
    "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 Apr 7, 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.