Provider Demographics
NPI:1548417827
Name:THE THRESHOLDS
Entity Type:Organization
Organization Name:THE THRESHOLDS
Other - Org Name:KANKAKEE RIVER HOUSE CILA
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:MARCELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-572-5480
Mailing Address - Street 1:4101 N RAVENSWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2193
Mailing Address - Country:US
Mailing Address - Phone:773-572-5500
Mailing Address - Fax:773-537-3488
Practice Address - Street 1:603-605 S POPLAR AVE
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-5547
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:2008-08-19
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04133Medicaid
IL=========Medicaid