Provider Demographics
NPI:1043450794
Name:RODASI LLC
Entity Type:Organization
Organization Name:RODASI LLC
Other - Org Name:ARDENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:F
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:888-870-1775
Mailing Address - Street 1:684 S BARRINGTON RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-1841
Mailing Address - Country:US
Mailing Address - Phone:888-870-1775
Mailing Address - Fax:847-349-1619
Practice Address - Street 1:2500 W. HIGGINS RD
Practice Address - Street 2:UNIT 105
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-2040
Practice Address - Country:US
Practice Address - Phone:888-870-1775
Practice Address - Fax:847-349-1619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166000736106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL166000736OtherSTATE LICENSE
IL180006449OtherSTATE LICENSE