Organization
ABBOTT HOUSE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. IVY K FISHMAN MHA (ADMINISTRATOR)
(847) 432-6080
Entity
Organization
Contact information
Practice address
405 CENTRAL AVE, HIGHLAND PARK, IL 60035-2622
(847) 432-6080
(847) 432-7286
Mailing address
405 CENTRAL AVE, HIGHLAND PARK, IL 60035-2622
(847) 432-6080
(847) 432-7286
Taxonomy
Speciality
Code
Description
License number
State
310500000X
Mental Illness Intermediate Care Facility
Primary
0023739
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0023739
PUBLIC HEALTH LICENSE NUM
IL
Enumeration date
03/15/2007
Last updated
08/22/2020
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