Organization
ALEXIAN BROTHERS BEHAVIORAL HEALTH HOSPITAL
Active
Parent organization
ALEXIAN BROTHERS BEHAVIORAL HEALTH HOSPITAL
Other names
Foglia Residential Treatment Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
ALEXIAN BROTHERS BEHAVIORAL HEALTH HOSPITAL
Authorized official
MARY JO MACKNISKAS (SR. DIRECTOR, NET REVENUE AND REIMB)
(773) 213-0776
Entity
Organization
Contact information
Practice address
801 GLOUCESTER DR, ELK GROVE VILLAGE, IL 60007-3319
(847) 981-5900
Mailing address
1650 MOON LAKE BLVD, HOFFMAN ESTATES, IL 60169-1010
(773) 213-0776
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A-9905-0003-A
SUPR LICENSE
IL
Enumeration date
01/20/2023
Last updated
01/20/2023
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