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Providence Center
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Chicago, Illinois
NPI 1417305897

Providence Center is a Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility based in Chicago, IL. Providence Center practices in Chicago, IL. The NPI Number for Providence Center is 1417305897 and holds a License No. 2000404 (Illinois).

The current practice location address for Providence Center is 4200 N Austin Ave, Chicago, IL and can be reached out via phone at 773-545-8300.

Location: 4200 N Austin Ave, Chicago, IL, 60634-1615
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1417305897
Provider Name
Providence Center
Credential
Provider Entity Type
Organization
Address
4200 N Austin Ave, Chicago, IL, 60634-1615
Phone Number
773-545-8300
Fax Number
Provider Enumeration Date
05/26/2016
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
14G191 05 IL
institution
Provider Business Practice Location Address Details
Address
4200 N Austin Ave
City
Chicago
State
Illinois
Zip
60634-1615
Phone Number
773-545-8300
Fax Number
person
Provider Business Mailing Address Details
Address
4200 N Austin Ave
City
Chicago
State
Illinois
Zip
60634-1615
Phone Number
773-545-8300
Fax Number
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
320900000X
License No.
2000404 (Illinois)
Definition
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
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