Organization
MIDWEST BRAIN INJURY CLUBHOUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMIKO BESS (EXECUTIVE DIRECTOR)
(312) 226-8714
Entity
Organization
Contact information
Practice address
1021 W ADAMS ST., SUITE 200, CHICAGO, IL 60607-2936
(312) 226-8720
(312) 226-8722
Mailing address
1021 W ADAMS ST STE 200, CHICAGO, IL 60607-2936
(312) 226-8720
(312) 226-8722
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251E00000X
Home Health Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261Q00000X
Clinic/Center
—
—
261QA0600X
Adult Day Care Clinic/Center
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
10/14/2014
Last updated
12/20/2023
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