WESTERN LAKE (NPI# 1992893010) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1992893010 |
Entity Type | Organization |
Organization Name | WESTERN LAKE |
Other Organization Name | COUNSELING & DUI PROGRAMS LLC |
Practice Address |
21 W Grand Ave Fox Lake IL 60020-1209 |
Practice Telephone | 8475879700 |
Practice Fax Number | 8475878584 |
Mailing Telephone | 8475879700 |
Mailing Fax Number | 8475878584 |
Enumeration Date | 2006-10-11 |
Last Update Date | 2008-07-16 |
Authorized Official Name | MR. JEFF ROY HEDIEN (DIRECTOR/ SOLE MBR OWNER) |
Authorized Official Telephone | 8475879700 |
Authorized Official Credential | MA NCC CADC |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 251S00000X | Community/Behavioral Health | A-1450-0002-A | IL | Agencies |
State | Issuer | Identifier | Type Code |
---|---|---|---|
DEPT OF HUMAN SERVICES OFFICE OF ALCOHOL & SUBSTANCE ABUSE (DHS/ | A 1450 0002 A | 01 |
Other Name | Type Code |
---|---|
COUNSELING & DUI PROGRAMS LLC | Former Legal Business Name - Organization |
Entity Type | Entity Name | Entity Address |
---|---|---|
New York State Corporations | WESTERN LAKE ONTARIO CHARTER ASSOCIATION, INC. | John J Polandick, 177 Sherwood Dr, Hilton, Ny 14468 |
New York State Corporations | WESTERN LAKE ONTARIO CONSERVANCY, LIMITED | 4819 Bragg Schoolhouse Rd, Albion, Ny 14411 |
Washington State Corporations | WESTERN LAKES CORPORATION | 16377 Taylor Rd, Mount Vernon, WA 98273-8544 |
Street Address |
21 W GRAND AVE |
City | FOX LAKE |
State | IL |
Zip Code | 60020-1209 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1043510621 | Northwestern Lake Counseling | Early Intervention Provider Agency | 17 West Grand Ave., Fox Lake, IL 60020 | 2010-10-28 |
1124074653 | American Drug Stores LLC | Durable Medical Equipment & Medical Supplies | 1350 S Route 12, Fox Lake, IL 60020 | 2006-05-26 |
1063903417 | Crystal C Scholten | Physical Therapist | 1294 S Route 12, Fox Lake, IL 60020 | 2018-05-22 |
1639525116 | Fox Lake Fire Protection District | General Acute Care Hospital | 306 Washington Ave, Fox Lake, IL 60020 | 2016-05-13 |
1598075269 | David Torres | Counselor | 17 W Grand Ave, Fox Lake, IL 60020 | 2010-10-15 |
1972843175 | Surgical Assistant Innovations, LLC | Registered Nurse | 1236 Shagbark Ct, Fox Lake, IL 60020-0806 | 2013-02-25 |
1073982583 | Sharilee Shaver | Social Worker | 7105 Saint Tropez Ct, Fox Lake, IL 60020-1040 | 2015-09-15 |
1356679534 | Darlene Krieger | Counselor | 17 W Grand Ave, Fox Lake, IL 60020-1209 | 2009-11-25 |
1992330278 | Nancy D Bourke | Counselor | 34 W Grand Ave, Fox Lake, IL 60020-1224 | 2020-03-07 |
1790258408 | Bailey Behavioral Health, LLC | Counselor | 34 W Grand Ave Ste 101, Fox Lake, IL 60020-1224 | 2019-01-04 |
Find all providers in zip 60020 |
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 |
---|---|---|---|---|
1144820648 | Community Wellness Group | Community/Behavioral Health | 635 Argyle Ave, Flossmoor, IL 60422-1201 | 2020-10-26 |
1437758711 | Gina Baldacci, Lcsw, LLC | Community/Behavioral Health | 231 Longridge Dr, Bloomingdale, IL 60108 | 2020-10-19 |
1790383610 | Joni Lamb Therapy, LLC | Community/Behavioral Health | 1555 Sherman Ave # 308, Evanston, IL 60201-4421 | 2020-10-13 |
1811594906 | Everyday Empowered Clinical Services, Ltd. | Community/Behavioral Health | 5117 Main St, Suite #7, Downers Grove, IL 60515 | 2020-10-02 |
1942817150 | Pacem Wellness, LLC | Community/Behavioral Health | 8 Eagle Ctr Ste 12, O Fallon, IL 62269-1947 | 2020-09-30 |
1831703271 | Boules Clinical Psychology Group | Community/Behavioral Health | 200 S Frontage Rd Ste 324, Burr Ridge, IL 60527-6953 | 2020-09-02 |
1336753896 | Counseling Kennedy Shenberg | Community/Behavioral Health | 5752 N Campbell Ave Apt 1, Chicago, IL 60659-5080 | 2020-09-02 |
1265045371 | Brightside Recovery | Community/Behavioral Health | 1667 Belvidere Rd, Belvidere, IL 61008-9306 | 2020-08-28 |
1902419021 | Brightside Recovery | Community/Behavioral Health | 8041 186th St Ste B, Tinley Park, IL 60487-9344 | 2020-08-28 |
1700498573 | Bobby E. Wright Comprehensive Behavioral Health Center, Inc. | Community/Behavioral Health | 5816 W Division St Fl 1, Chicago, IL 60651-1003 | 2020-08-21 |
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.