Organization
INDEPENDENCE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL PIERCE (EXECUTIVE DIRECTOR)
(847) 244-4442
Entity
Organization
Contact information
Practice address
817 INDIANA AVE, WAUKEGAN, IL 60085-2612
(847) 360-1020
Mailing address
2025 WASHINGTON ST, WAUKEGAN, IL 60085-5131
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/26/2008
Last updated
08/03/2011
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