Organization
INVICTUS PHOENIX NFP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUPAL M POTNIS MD (BOARD SECRETARY)
(847) 630-1164
Entity
Organization
Contact information
Practice address
1314 PAM ANNE DR, GLENVIEW, IL 60025-2517
(847) 630-1164
Mailing address
1314 PAM ANNE DR, GLENVIEW, IL 60025-2517
(847) 630-1164
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
07/10/2023
Last updated
07/12/2023
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