Organization
NICASA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA SNELTEN (DIR OF ADMINISTRATION)
(847) 546-6450
Entity
Organization
Contact information
Practice address
31979 N FISH LAKE RD, ROUND LAKE, IL 60073-9517
(847) 546-6450
(847) 546-6760
Mailing address
31979 N FISH LAKE RD, ROUND LAKE, IL 60073-9517
(847) 546-6450
(847) 546-6760
Taxonomy
Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
Primary
A-0614-0004-A
IL
Other
Enumeration date
05/18/2006
Last updated
08/13/2019
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