LAKE COUNTY CRISIS CENTER FOR THE PREVENTION AND TREATMENT OF DOMESTIC (NPI# 1336781293) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336781293 |
| Entity Type | Organization |
| Organization Name | LAKE COUNTY CRISIS CENTER FOR THE PREVENTION AND TREATMENT OF DOMESTIC |
| Practice Address |
2710 17th St Zion IL 60099-1543 |
| Practice Telephone | 8477317165 |
| Mailing Telephone | 8477317165 |
| Enumeration Date | 2019-10-11 |
| Last Update Date | 2019-10-11 |
| Authorized Official Name | PAT DAVENPORT (CEO) |
| Authorized Official Telephone | 8477317165 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| A Safe Place | Doing Business As Name - Organization |
| Street Address |
2710 17TH ST |
| City | ZION |
| State | IL |
| Zip Code | 60099-1543 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265033674 | Ghazala Raheel | Pharmacist | 4000 Route # 173, Zion, IL 60099 | 2020-11-03 |
| 1295384790 | Loretta Beatrice Colwell | Technician | 3005 Elizabeth Ave, Zion, IL 60099 | 2019-09-06 |
| 1053893164 | Tea Mohn | Psychologist | 3901 W. 21st Street, Zion, IL 60099 | 2018-09-05 |
| 1326540808 | Monica Donald | Specialist/Technologist | 2825 Jethro Ct, Zion, IL 60099 | 2018-03-01 |
| 1265816516 | Igor Wroblewski | Internal Medicine | 2505 26th St, Zion, IL 60099 | 2015-07-16 |
| 1831432996 | Samuel Harrison Cannon Jr. | Nurse Anesthetist, Certified Registered | 3302 Wembley Dr, Zion, IL 60099 | 2013-03-27 |
| 1619213618 | Lizel Ann Granada | Nurse Practitioner | 2723 Sheridan Road, Suite C, Zion, IL 60099 | 2012-12-19 |
| 1194070540 | Shana Marie Pagtalunan Ramirez | Physical Therapist | 2404 Joppa Ave., Zion, IL 60099 | 2012-07-20 |
| 1962674978 | Zion Benton Children's Service | Dentist | 1608 W 23rd St, Zion, IL 60099 | 2008-03-31 |
| 1710176110 | Highland Park Cvs, L.L.C. | Durable Medical Equipment & Medical Supplies | 4580 Rt. 173, Zion, IL 60099 | 2007-10-22 |
| Find all providers in zip 60099 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235777244 | Aspire of Illinois | Clinic/Center | 3441 Sheridan Rd, Zion, IL 60099-3662 | 2019-12-20 |
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|---|---|---|---|---|
| 1225639990 | Mindy Forman, Psyd, LLC | Clinic/Center | 1020 Milwaukee Ave Ste 110, Deerfield, IL 60015-3555 | 2020-11-07 |
| 1346840295 | Stopka Professional Counseling LLC | Clinic/Center | 13125 Steeplechase Dr, New Lenox, IL 60451-1320 | 2020-10-29 |
| 1346848785 | Wellness Hearted Therapy LLC | Clinic/Center | 2675 S Cedar Glen Dr, Arlington Heights, IL 60005-5303 | 2020-10-16 |
| 1457959256 | Association for Individual Development | Clinic/Center | 708 N Bridge St, Yorkville, IL 60560-1105 | 2020-10-14 |
| 1285231555 | Association for Individual Development | Clinic/Center | 236 W Crystal Lake Ave, Crystal Lake, IL 60014-5847 | 2020-10-08 |
| 1386241123 | Envision Unlimited | Clinic/Center | 1801 N Spaulding Ave, Chicago, IL 60647-4926 | 2020-10-05 |
| 1881291789 | Jessica Weisbach, LLC | Clinic/Center | 2257 N Kedzie Blvd Apt 3, Chicago, IL 60647-2561 | 2020-10-04 |
| 1619574803 | Envision Unlimited | Clinic/Center | 2124 W 82nd Pl, Chicago, IL 60620-5358 | 2020-10-01 |
| 1144827320 | Envision Unlimited | Clinic/Center | 4919 N Clark St, Chicago, IL 60640-3514 | 2020-10-01 |
| 1194322370 | Envision Unlimited | Clinic/Center | 4911 S Hoyne Ave, Chicago, IL 60609-4721 | 2020-10-01 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on LAKE COUNTY CRISIS CENTER FOR THE PREVENTION AND TREATMENT OF DOMESTIC.
| 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.