Organization
NICASA, NFP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA SNELTEN (CHIEF OPERATING OFFICER)
(847) 546-6450
Entity
Organization
Contact information
Practice address
2900 N MAIN ST, BUFFALO GROVE, IL 60089-2717
(847) 634-6422
(847) 364-6775
Mailing address
31979 N FISH LAKE RD, ROUND LAKE, IL 60073-9517
(847) 546-6450
(847) 546-6760
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
A-0614-0003
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A-0614-0003
—
IL
Enumeration date
10/07/2016
Last updated
04/06/2021
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