Provider Demographics
NPI:1528361177
Name:THRESHOLDS
Entity Type:Organization
Organization Name:THRESHOLDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:AL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOREIBAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-572-5262
Mailing Address - Street 1:4101 N RAVENSWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613
Mailing Address - Country:US
Mailing Address - Phone:773-572-5500
Mailing Address - Fax:773-271-2597
Practice Address - Street 1:6710 N SHERIDAN RD APT 206
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-4542
Practice Address - Country:US
Practice Address - Phone:773-572-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE THRESHOLDS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-20
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL04133251S00000X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health