Provider Demographics
NPI:1417574518
Name:CARITAS
Entity Type:Organization
Organization Name:CARITAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTS AND CREDENTIALING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSECA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-572-8228
Mailing Address - Street 1:1301 W 22ND ST STE 500
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2014
Mailing Address - Country:US
Mailing Address - Phone:630-572-8228
Mailing Address - Fax:630-572-0566
Practice Address - Street 1:140 N ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-1802
Practice Address - Country:US
Practice Address - Phone:312-850-9411
Practice Address - Fax:312-850-3288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder