Organization
NICASA, NFP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA SNELTEN (CHIEF OPERATING OFICER)
(847) 546-6450
Entity
Organization
Contact information
Practice address
1632 23RD ST, ZION, IL 60099-2345
(847) 872-2830
(847) 731-7785
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
251S00000X
Community/Behavioral Health Agency
A-0614-0007-A
IL
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
C/A-0614-0007-A
—
IL
Enumeration date
06/17/2014
Last updated
04/06/2021
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