Organization
ACCESS BEHAVIORAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERNESTINA ONTIVEROS MA (PRESIDENT/CEO)
(773) 522-5460
Entity
Organization
Contact information
Practice address
3948 W 26TH ST, SUITE 114, CHICAGO, IL 60623-3738
(773) 522-5460
(773) 522-5465
Mailing address
3948 W 26TH ST, SUITE 114, CHICAGO, IL 60623-3738
(773) 522-5460
(773) 522-5465
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
A-8712-0001-A
IL
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
A-8712-0001-A
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A-8712-0001-A
STATE LICENSE
IL
Enumeration date
03/15/2014
Last updated
03/15/2014
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