Independence Center in Waukegan - Community Based Residential Treatment Facility, Mental Illness
Independence Center - NPI 1235308057
Independence Center is a Community Based Residential Treatment Facility, Mental Illness in Waukegan, Illinois. Independence Center practices all healthcare services and medical treatments related to Community Based Residential Treatment Facility, Mental Illness. The NPI Number for Independence Center is 1235308057. The last update date is 2011-08-03.
Independence Center's current location address is 817 Indiana Ave, Waukegan, Illinois. You can contact this provider via phone number 8473601020. The mailing address for Independence Center is 817 Indiana Ave, Waukegan, Illinois. To know further, please read the information below!
Provider Profile Detail
| Provider Organization | Independence Center |
|---|---|
| Address | 817 Indiana Ave, Waukegan, Illinois |
| Phone Number | 8473601020 |
| Fax Number | |
| Sole Proprietor | -- |
| Credentials | -- |
Authorized Official
| Title or Position | EXECUTIVE |
|---|---|
| Authorized Official Name | Pierce Michael |
| Telephone Number | 8472444442 |
NPI Number Detail
| NPI Number | 1235308057 |
|---|---|
| Provider Enumeration Date | 2008-02-26 |
| Last Updated Date | 2011-08-03 |
Provider Mailing Address Detail
| Address | 817 Indiana Ave |
|---|---|
| City | Waukegan |
| State | Illinois (IL) |
| Post Code | 600852612 |
| Phone Number | 8473601020 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Community Based Residential Treatment Facility, Mental Illness |
|---|---|
| Taxonomy | 320800000X |
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Definition: A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
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What is the unique 10-digit identification code assigned to Independence Center by the Centers for Medicare & Medicaid Services?
The Independence Center has been issued the NPI (National Provider Identifier) 1235308057, which serves as a unique identifier for healthcare providers, assigned by the Centers for Medicare & Medicaid Services (CMS).
Can you provide the Independence Center's physical address?
The Independence Center is physically located at 817 Indiana Ave, in the city of Waukegan, IL, with the postal code 600852612.
What is the Independence Center's specialty and taxonomy code?
The Independence Center's specialty is Community Based Residential Treatment Facility, Mental Illness, and the corresponding taxonomy code is 320800000X.
On what date did Independence Center receive its 1235308057 assignment from the Centers for Medicare & Medicaid Services?
The Independence Center was assigned its 1235308057 on 2008-02-26, which is the date when this unique identifier was issued to the organization by the Centers for Medicare & Medicaid Services.
When was the information pertaining to Independence Center most recently updated or revised?
The details related to Independence Center, including its address, specialty, and other relevant information, were last updated or revised on 2011-08-03.