Provider Demographics
NPI:1225063472
Name:CLEARBROOK
Entity Type:Organization
Organization Name:CLEARBROOK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:M
Authorized Official - Last Name:LA MELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-870-7711
Mailing Address - Street 1:1835 W CENTRAL ROAD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2410
Mailing Address - Country:US
Mailing Address - Phone:847-870-7711
Mailing Address - Fax:847-870-7741
Practice Address - Street 1:1835 W CENTRAL ROAD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2410
Practice Address - Country:US
Practice Address - Phone:847-870-7711
Practice Address - Fax:847-870-7741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL033023Medicaid
IL037820Medicaid
IL033035Medicaid
IL033027Medicaid