Provider Demographics
NPI:1427592013
Name:SPECIALIZED ASSISTANCE SERVICES, NFP
Entity Type:Organization
Organization Name:SPECIALIZED ASSISTANCE SERVICES, NFP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:A.
Authorized Official - Middle Name:DORIS
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:312-808-3218
Mailing Address - Street 1:2630 S WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2825
Mailing Address - Country:US
Mailing Address - Phone:312-808-3218
Mailing Address - Fax:312-791-9037
Practice Address - Street 1:333 W EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:MANTENO
Practice Address - State:IL
Practice Address - Zip Code:60950-9329
Practice Address - Country:US
Practice Address - Phone:815-468-6556
Practice Address - Fax:815-468-1098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-0584-0002-A261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========004Medicaid