Organization
ALEXIAN BROTHERS
Active
Other names
Bonaventure House
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BART WINTERS (CEO)
(773) 327-9921
Entity
Organization
Contact information
Practice address
825 W WELLINGTON AVE, CHICAGO, IL 60657-5123
(773) 327-9921
Mailing address
825 W WELLINGTON AVE, CHICAGO, IL 60657-5123
(773) 327-9921
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
A-0977-0001-A
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3000101
IDPH LICENSE
IL
01
—
A09770001A
IDHS DASA LICENSE
IL
Enumeration date
05/14/2007
Last updated
08/22/2020
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