Provider Demographics
NPI:1598211021
Name:THE IDS GROUP
Entity Type:Organization
Organization Name:THE IDS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:IDERAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:630-893-8470
Mailing Address - Street 1:644 E IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-2303
Mailing Address - Country:US
Mailing Address - Phone:630-893-8470
Mailing Address - Fax:
Practice Address - Street 1:644 E IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-2303
Practice Address - Country:US
Practice Address - Phone:630-893-8470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA31870006A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty