Organization
LESTER & ROSALIE ANIXTER CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY DESMOND (DIRECTOR OF FINANCE)
(773) 761-1501
Entity
Organization
Contact information
Practice address
4920 N KENMORE AVE, CHICAGO, IL 60640-3710
(773) 761-1501
Mailing address
6610 N CLARK ST, CHICAGO, IL 60626-4062
(773) 761-1501
(773) 274-3523
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
A-0998-0013-A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A-0998-0013-A
—
IL
Enumeration date
08/08/2018
Last updated
08/08/2018
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