Organization
ADVOCATE NORTHSIDE HEALTH SYSTEM
Active
Other names
ADVOCATE ILLINOIS MASONIC MEDICAL CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
KARA RICHARDSON (VP MANAGED HEALTH)
(980) 416-4068
Entity
Organization
Contact information
Practice address
913 W WELLINGTON AVE FL 2, CHICAGO, IL 60657-6709
(873) 843-0200
Mailing address
PO BOX 70508, CHICAGO, IL 60673-0508
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
04004
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04004
—
IL
Enumeration date
09/09/2011
Last updated
04/21/2026
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