Provider Demographics
NPI:1124579073
Name:UPTOWN DUI SERVICES
Entity Type:Organization
Organization Name:UPTOWN DUI SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DUI / TREATMENT PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:FITZGERALD
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:CADC, MISA I, DUI
Authorized Official - Phone:312-451-5184
Mailing Address - Street 1:1525 E 53RD ST STE 411
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4530
Mailing Address - Country:US
Mailing Address - Phone:312-451-5184
Mailing Address - Fax:708-896-6580
Practice Address - Street 1:1525 E 53RD ST STE 411
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4530
Practice Address - Country:US
Practice Address - Phone:312-451-5184
Practice Address - Fax:708-896-6580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-16
Last Update Date:2016-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL302F00000X302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization