Organization
CARITAS
Active
Parent organization
CARITAS
Other names
Caritas Central Intake
Organization subpart
Yes
Provider details
NPI number
Legal business name
CARITAS
Authorized official
JESSECA WATSON (CREDENTIALING MANAGER)
(630) 572-8228
Entity
Organization
Contact information
Practice address
140 NORTH ASHLAND AVENUE, CHICAGO, IL 60607
(312) 850-9411
(312) 850-3288
Mailing address
1301 WEST 22ND STREET, SUITE 500, OAK BROOK, IL 60523
(630) 572-0556
(630) 572-0566
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023
—
IL
01
—
A-0554-0001-A
ILLINOIS DEPARTMENT OF HUMAN SERVICES - SUPR
IL
Enumeration date
01/30/2007
Last updated
02/12/2021
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