Provider Demographics
NPI:1144763269
Name:ERC INSIGHT
Entity Type:Organization
Organization Name:ERC INSIGHT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWMARK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-383-4817
Mailing Address - Street 1:421 W BARRY AVE
Mailing Address - Street 2:APT 203
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5545
Mailing Address - Country:US
Mailing Address - Phone:773-383-4817
Mailing Address - Fax:
Practice Address - Street 1:200 E OHIO ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-7269
Practice Address - Country:US
Practice Address - Phone:773-572-8386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EATING RECOVERY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.017861323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility