ILLINOIS MEDICAID-SUBSTANCE ABUSE MACOMB (NPI# 1588032460) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588032460 |
| Entity Type | Organization |
| Organization Name | ILLINOIS MEDICAID-SUBSTANCE ABUSE MACOMB |
| Practice Address |
900 S Deer Rd Macomb IL 61455-2639 |
| Practice Telephone | 3098374876 |
| Mailing Telephone | 3098374876 |
| Enumeration Date | 2015-09-09 |
| Last Update Date | 2019-08-19 |
| Authorized Official Name | MR. BILL A NELSON (CEO) |
| Authorized Official Telephone | 3093444200 |
| Authorized Official Credential | LCPC |
| Is Organization Subpart | Y |
| Parent Organization Name | BRIDGEWAY INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
A-0118-0010-A | IL | Behavioral Health & Social Service Providers |
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
IL | Allopathic & Osteopathic Physicians | |
| N | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
IL | Allopathic & Osteopathic Physicians | |
| N | 261QM2800X |
Clinic/Center Specialization: Methadone Clinic |
Ambulatory Health Care Facilities | ||
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
IL | Ambulatory Health Care Facilities |
| Street Address |
900 S DEER RD |
| City | MACOMB |
| State | IL |
| Zip Code | 61455-2639 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396867420 | John Robert Prain | Counselor | 900 S Deer Rd, Macomb, IL 61455-2639 | 2007-04-06 |
| 1104394295 | Aimee Anderson | Counselor | 900 S Deer Rd, Macomb, IL 61455-2639 | 2018-11-06 |
| 1902385222 | Crystal D Stimpson | Registered Nurse | 900 S Deer Rd, Macomb, IL 61455-2639 | 2018-08-08 |
| 1457625592 | Amanda Michele Bolte | Counselor | 900 S Deer Rd, Macomb, IL 61455-2639 | 2012-03-07 |
| 1821217084 | Kathleen E Markey | Registered Nurse | 900 S Deer Rd, Macomb, IL 61455-2639 | 2007-04-25 |
| 1518185925 | Bridgeway Inc | Psychiatry & Neurology | 900 S Deer Rd, Macomb, IL 61455-2639 | 2007-04-23 |
| 1629292156 | Rachelle D Mccoy | Registered Nurse | 900 S Deer Rd, Macomb, IL 61455-2639 | 2007-04-13 |
| 1629292123 | Dorothy J Loop | Registered Nurse | 900 S Deer Rd, Macomb, IL 61455-2639 | 2007-04-13 |
| 1982827499 | Bridgeway, Inc | Community/Behavioral Health | 900 S Deer Rd, Macomb, IL 61455-2639 | 2007-04-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043869944 | Wesley Village, Inc | Speech-Language Pathologist | 1200 East Grant Street, Macomb, IL 61455 | 2019-09-04 |
| 1780154013 | Hannah Lauren Bengtson | Optometrist | 820 E. Jackson St., Macomb, IL 61455 | 2018-11-29 |
| 1255832564 | Lifeguard Ambulance Service of Illinois Inc. | Ambulance | 219 W Jackson St, Macomb, IL 61455 | 2018-02-22 |
| 1821516816 | Michelle Deann Sargeant | Speech-Language Pathologist | 315 N. Bonham, Macomb, IL 61455 | 2017-08-30 |
| 1972020360 | Kara Marie Wright | Speech-Language Pathologist | 315 N. Bonham St., Macomb, IL 61455 | 2017-08-25 |
| 1720356504 | Dawn M. Kedzior | Social Worker | 103 South Johnson Street, Macomb, IL 61455 | 2011-12-07 |
| 1255632642 | Michael Kurt Sharp | Audiologist | Memorial Hall, Second Floor, W Murray St, Macomb, IL 61455 | 2010-11-16 |
| 1952538704 | Mary L. Smith | Developmental Therapist | 1 University Circle, Western Il Univ, Cntr for Best Practices In Early Childhood Education, Macomb, IL 61455 | 2009-06-19 |
| 1982857827 | Macomb Oncology Institute Ltd | Radiology | 401 East Grant Street, Macomb, IL 61455 | 2008-10-23 |
| 1245488345 | Sonja E Schmidt | Social Worker | 119 Wetzel Hall, Western Illinois University, Macomb, IL 61455 | 2008-09-03 |
| Find all providers in zip 61455 | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
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|---|---|---|---|---|
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| 1164036661 | Existential Counselor Societ Ltd. | Clinic/Center | 1225 Richards St, Joliet, IL 60433-2745 | 2020-09-02 |
| 1457964934 | Rosecrance Inc | Clinic/Center | 15 N Galena Ave, Freeport, IL 61032-4348 | 2020-08-25 |
| 1922617133 | Recovery Concepts Urbana, LLC | Clinic/Center | 710 W. Killarney St., Urbana, IL 61801 | 2020-07-24 |
| 1174148167 | Associates In Behavioral Health Care | Clinic/Center | 910 Lake St Ste 102, Roselle, IL 60172-3384 | 2020-06-15 |
| 1538784533 | Associates In Behavioral Health Care | Clinic/Center | 1375 E Schaumburg Rd Ste 120, Schaumburg, IL 60194-3643 | 2020-06-15 |
| 1265056964 | Gateway Foundation, Inc. | Clinic/Center | 3040 Finley Rd, Downers Grove, IL 60515-5713 | 2020-05-29 |
| 1922634021 | Lutheran Social Services of Illinois | Clinic/Center | 400 N Cherry St, Morrison, IL 61270-2605 | 2020-03-20 |
| 1144852260 | Vincent Wallace | Clinic/Center | 226 W Ontario St, Chicago, IL 60654-3619 | 2020-02-06 |
| 1093354037 | A Bridge Back, Inc. | Clinic/Center | 314 Mchenry Rd, Buffalo Grove, IL 60089-2428 | 2019-12-21 |
| Find all providers with the same taxonomy | ||||
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| 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.