Provider Demographics
NPI:1528398096
Name:FAMILY GUIDANCE CENTERS, INC.
Entity Type:Organization
Organization Name:FAMILY GUIDANCE CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NOTTAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-943-6545
Mailing Address - Street 1:2618 PATRIOT BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-8024
Mailing Address - Country:US
Mailing Address - Phone:224-659-7030
Mailing Address - Fax:224-659-7035
Practice Address - Street 1:120 N 11TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-1002
Practice Address - Country:US
Practice Address - Phone:217-544-9858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA05210015A261QM2800X, 261QR0405X
324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility