Provider Demographics
NPI:1710344338
Name:SPECIALIZED ASSISTANCE SERVICES, NFP
Entity Type:Organization
Organization Name:SPECIALIZED ASSISTANCE SERVICES, NFP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE & ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-808-3218
Mailing Address - Street 1:2630 S WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2825
Mailing Address - Country:US
Mailing Address - Phone:312-808-3218
Mailing Address - Fax:312-791-9037
Practice Address - Street 1:333 W EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:MANTENO
Practice Address - State:IL
Practice Address - Zip Code:60950
Practice Address - Country:US
Practice Address - Phone:312-808-3218
Practice Address - Fax:312-791-9037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-27
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0405X, 324500000X
ILA-0584-0004-A332900000X
ILA-0584-0002-A332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No332900000XSuppliersNon-Pharmacy Dispensing Site