INDEPENDENCE CENTER, INC. (NPI# 1174709810) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174709810 |
| Entity Type | Organization |
| Organization Name | INDEPENDENCE CENTER, INC. |
| Practice Address |
2025 Washington St Waukegan IL 60085-5131 |
| Practice Telephone | 8473601020 |
| Practice Fax Number | 8473601065 |
| Mailing Telephone | 8473601020 |
| Mailing Fax Number | 8473601065 |
| Enumeration Date | 2008-01-11 |
| Last Update Date | 2016-11-04 |
| Authorized Official Name | MS. LISA JOHNSON (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 8473601020 |
| Authorized Official Credential | LCPC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 251B00000X | Case Management | Agencies | ||
| N | 320800000X | Community Based Residential Treatment Facility, Mental Illness | Residential Treatment Facilities | ||
| N | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities | ||
| N | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
Ambulatory Health Care Facilities | ||
| Y | 251S00000X | Community/Behavioral Health | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MEDICARE PTAN | IL6331 | 01 |
| Street Address |
2025 WASHINGTON ST |
| City | WAUKEGAN |
| State | IL |
| Zip Code | 60085-5131 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316547656 | Keli R Poppe | Psychologist | 2025 Washington St, Waukegan, IL 60085-5131 | 2020-10-27 |
| 1780283184 | Justin Kimbel | Social Worker | 2025 Washington St, Waukegan, IL 60085-5131 | 2020-10-19 |
| 1588262109 | Anna Bridget Crofts | Social Worker | 2025 Washington St, Waukegan, IL 60085-5131 | 2020-10-15 |
| 1790383511 | Lorraine Eileen Waller | Counselor | 2025 Washington St, Waukegan, IL 60085-5131 | 2020-10-14 |
| 1508464330 | Theresa Lynn Mugerditchian | Social Worker | 2025 Washington St, Waukegan, IL 60085-5131 | 2020-10-14 |
| 1184222135 | Paul Mazzetta | Social Worker | 2025 Washington St, Waukegan, IL 60085-5131 | 2020-10-13 |
| 1679171789 | Madison Lapidus | Social Worker | 2025 Washington St, Waukegan, IL 60085-5131 | 2020-10-12 |
| 1588270656 | Alona Diane Miller | Counselor | 2025 Washington St, Waukegan, IL 60085-5131 | 2020-09-23 |
| 1649895699 | Amber Hamby | Psychologist | 2025 Washington St, Waukegan, IL 60085-5131 | 2020-06-15 |
| 1497380463 | Chelsey Glatz | Student in an Organized Health Care Education/Training Program | 2025 Washington St, Waukegan, IL 60085-5131 | 2020-03-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285285189 | Allison Rose Matuszewski | Speech-Language Pathologist | Robbie M. Lightfoot, 1721 N Mcaree Rd, Waukegan, IL 60085 | 2019-09-23 |
| 1164985602 | Kristin Kaprak | Speech-Language Pathologist | Thomas Jefferson Middle School, 600 S. Lewis, Waukegan, IL 60085 | 2019-04-11 |
| 1861972317 | Mitchum Smith | Student in an Organized Health Care Education/Training Program | 2025 Washington Street, Waukegan, IL 60085 | 2018-08-15 |
| 1447702998 | Rachel Martinez | Registered Nurse | 3002 Grand Ave., Waukegan, IL 60085 | 2016-11-01 |
| 1831649250 | Kenneth Caples | Specialist/Technologist | 211 S County St, Waukegan, IL 60085 | 2016-10-10 |
| 1033666490 | Catholic Charities of The Archdiocese of Chicago | Community/Behavioral Health | 671 S. Lewis Ave., Waukegan, IL 60085 | 2016-09-02 |
| 1285007757 | Michael Moore | Counselor | 1113 Greenwood Ave, Waukegan, IL 60085 | 2015-11-05 |
| 1740656503 | Emperatriz Guerra | Counselor | 329 N. Genesee Street, Waukegan, IL 60085 | 2015-08-17 |
| 1992189880 | County of Lake | Clinic/Center | 540 S. Mcalister Ave., Waukegan, IL 60085 | 2015-07-10 |
| 1922406354 | Ebele Okonkwor | Nurse Anesthetist, Certified Registered | 1324 N. Sheridan, Waukegan, IL 60085 | 2014-12-17 |
| Find all providers in zip 60085 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710448089 | Chicago Hope Services | Community/Behavioral Health | 430 Cory Ave, Waukegan, IL 60085-4027 | 2019-03-28 |
| 1033666490 | Catholic Charities of The Archdiocese of Chicago | Community/Behavioral Health | 671 S. Lewis Ave., Waukegan, IL 60085 | 2016-09-02 |
| 1851715205 | Nicasa, Nfp | Community/Behavioral Health | 1113 W Greenwood Ave, Waukegan, IL 60087-4908 | 2014-02-05 |
| 1265767214 | One Hope United | Community/Behavioral Health | 2115 S Ernie Krueger Cir, Waukegan, IL 60087-4156 | 2009-10-08 |
| 1619146420 | Independence Center | Community/Behavioral Health | 320 N Ash St, Waukegan, IL 60085-3985 | 2008-02-26 |
| 1720290091 | County of Lake | Community/Behavioral Health | 3004 Grand Ave, Waukegan, IL 60085-2321 | 2007-05-07 |
| 1477765741 | County of Lake | Community/Behavioral Health | 2410 Belvidere Rd, Waukegan, IL 60085-6165 | 2007-05-07 |
| 1174745160 | County of Lake | Community/Behavioral Health | 3010 Grand Ave., Waukegan, IL 60085 | 2007-05-02 |
| 1356888515 | County of Lake | Community/Behavioral Health | 3010 Grand Ave, Waukegan, IL 60085-2321 | 2017-01-26 |
| 1093181141 | Truth Youth & Family Services, LLC | Community/Behavioral Health | 2504 Washington St., 300 B/c, Waukegan, IL 60085 | 2015-08-12 |
| Find all providers in WAUKEGAN | ||||
Please comment or provide details below to improve the information on INDEPENDENCE CENTER, INC..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.