Provider Demographics
NPI:1568148344
Name:FORESIGHT BEHAVIORAL HEALTH CLINIC OF HUMBOLDT PARK LLC
Entity Type:Organization
Organization Name:FORESIGHT BEHAVIORAL HEALTH CLINIC OF HUMBOLDT PARK LLC
Other - Org Name:SKS HOSPITALITY SERVICES, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:HYLAK-REINHOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-414-1342
Mailing Address - Street 1:303 E WACKER DR STE 2110
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-5312
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1811 W NORTH AVE STE 201
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-1488
Practice Address - Country:US
Practice Address - Phone:312-414-1341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-26
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health