Organization
PROVIDENCE FARM
Active
Organization
PROVIDENCE FARM
Active
Parent organization
PROVIDENCE FARM
Other names
Providence Farm Clinical Services
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE FARM
Authorized official
STEPHANIE ZWILLING LCSW (EXECUTIVE DIRECTOR)
(847) 409-6230
Entity
Organization
Contact information
Practice address
400 CENTRAL AVE STE 340, NORTHFIELD, IL 60093-3039
(847) 409-6230
Mailing address
400 CENTRAL AVE STE 340, NORTHFIELD, IL 60093-3039
(847) 409-6230
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
08/23/2024
Last updated
08/23/2024
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