PRENTICE PLACE (NPI# 1548774961) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548774961 |
| Entity Type | Organization |
| Organization Name | PRENTICE PLACE |
| Practice Address |
255 W 112th Pl Chicago IL 60628-4132 |
| Mailing Address |
1115 S Plymouth Ct Apt 501 Chicago IL 60605-2032 |
| Practice Telephone | 7733913123 |
| Practice Fax Number | 7737016844 |
| Mailing Telephone | 7733913123 |
| Mailing Fax Number | 3127533326 |
| Enumeration Date | 2017-11-21 |
| Last Update Date | 2017-11-21 |
| Authorized Official Name | MR. PRENTICE EARL (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 7733913123 |
| Authorized Official Credential | CADC,NCRS,CAMSLL |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | Residential Treatment Facilities |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | Prentice Place Holdings, L.L.C. | 8301 E. Prentice Ave., Ste. 100, Greenwood Village, CO 80111 |
| System for Award Management (SAM) Entities | PRENTICE PLACE LOFTS LIMITED PARTNERSHIP | 2487 S Cook St, Denver, CO 80210-5528 |
| Colorado Business Entities | Prentice Place RJ WDP LLC | 131 South Higgins, Suite P-1, Missoula, MT 59802 |
| Street Address |
255 W 112TH PL |
| City | CHICAGO |
| State | IL |
| Zip Code | 60628-4132 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750857942 | Myrna Pledger | Counselor | 259 W. 104th Pl., Chicago, IL 60628 | 2018-10-16 |
| 1073097184 | 4every1 Lab Inc. | Clinical Medical Laboratory | 10723 S Halsted St, Chicago, IL 60628 | 2018-09-24 |
| 1922594613 | Northwest Adult Wellness Center LLC | Clinic/Center | 235 W 95th Suite 3, Chicago, IL 60628 | 2018-07-05 |
| 1285152801 | Brittany Bellamy | Developmental Therapist | 10333 S Prairie, Chicago, IL 60628 | 2017-09-04 |
| 1598293839 | Denise Marie Mercherson | Social Worker | 9561 S. Union, Chicago, IL 60628 | 2017-05-31 |
| 1659821221 | Tca Health Care | Dentist | 1030 E. 130th St, Chicago, IL 60628 | 2016-10-07 |
| 1528432697 | Global Dialysis, LLC | Registered Nurse | 9746 South Harvard Ave., Chicago, IL 60628 | 2015-11-30 |
| 1871966382 | Kirby Rehabilitation, Inc | Clinic/Center | 723 W. 111th St, Chicago, IL 60628 | 2015-11-05 |
| 1851638605 | Marketa Marvanova | Pharmacist | 9501 S. King Drive, Douglas Hall 203-23, Chicago State University College of Pharmacy, Chicago, IL 60628 | 2013-01-14 |
| 1841567377 | Emma Goodman | Pharmacist | 10620 S. Halsted St, Chicago, IL 60628 | 2011-11-29 |
| Find all providers in zip 60628 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063989143 | Northwest Recovery Center LLC | Substance Abuse Rehabilitation Facility | 5352 N Lincoln Ave Ste 250, Chicago, IL 60625-2316 | 2018-10-26 |
| 1982182671 | Rosecrance, Inc. | Substance Abuse Rehabilitation Facility | 2835 N Sheffield Ave Ste 209, Chicago, IL 60657-5083 | 2018-08-03 |
| 1619453610 | Head Heart Therapy | Substance Abuse Rehabilitation Facility | 4809 N Ravenswood Ave Unit 227, Chicago, IL 60640-4417 | 2018-07-13 |
| 1891296802 | The Ids Group Chicago | Substance Abuse Rehabilitation Facility | 1117 N Ashland Ave, Chicago, IL 60622-3986 | 2018-02-25 |
| 1821537739 | Cornerstone Recovering Community | Substance Abuse Rehabilitation Facility | 28 W 113th Pl, Chicago, IL 60628-4811 | 2017-02-13 |
| 1538608443 | Cornerstone Recovering Community | Substance Abuse Rehabilitation Facility | 44 W 112th Pl, Chicago, IL 60628-4806 | 2017-02-13 |
| 1093254906 | Cornerstone Recovering Community | Substance Abuse Rehabilitation Facility | 139 W 112th St, Chicago, IL 60628-4803 | 2017-02-13 |
| 1083152359 | Cornerstone Recovering Community | Substance Abuse Rehabilitation Facility | 103 W 112th St, Chicago, IL 60628-4803 | 2017-02-07 |
| 1336529858 | Rosecrance Inc | Substance Abuse Rehabilitation Facility | 1556 W. Waveland Avenue, Chicago, IL 60613-3601 | 2015-06-01 |
| 1861870503 | Mcdermott Center | Substance Abuse Rehabilitation Facility | 10000 West Ohare Avenue, O'hare International Airport, Chicago, IL 60666 | 2015-05-14 |
| Find all providers in CHICAGO | ||||
Please comment or provide details below to improve the information on PRENTICE PLACE.
| 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.