Organization
THRESHOLDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK FURLONG (VP)
(773) 572-5390
Entity
Organization
Contact information
Practice address
4423 N RAVENSWOOD AVE, CHICAGO, IL 60640-5802
(773) 572-5500
Mailing address
4101 N RAVENSWOOD AVE, CHICAGO, IL 60613-2193
(773) 572-5500
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
12/11/2013
Last updated
12/11/2013
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