Provider Demographics
NPI:1003280744
Name:ANCHOR BEHAVIORAL CENTERS INC.
Entity Type:Organization
Organization Name:ANCHOR BEHAVIORAL CENTERS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUBSTANCE ABUSE COUNSELOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:MONTALVO
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:312-254-5035
Mailing Address - Street 1:79 W MONROE ST
Mailing Address - Street 2:#920
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-4901
Mailing Address - Country:US
Mailing Address - Phone:312-254-5035
Mailing Address - Fax:312-275-7778
Practice Address - Street 1:111 E CHESTNUT ST
Practice Address - Street 2:#48C
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2051
Practice Address - Country:US
Practice Address - Phone:312-254-5035
Practice Address - Fax:312-275-7775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0174791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty