Provider Demographics
NPI:1821535618
Name:WESTCARE ILLINOIS, INC
Entity Type:Organization
Organization Name:WESTCARE ILLINOIS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL VICE PRESEDIENT
Authorized Official - Prefix:
Authorized Official - First Name:STAVY
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNROE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-568-7051
Mailing Address - Street 1:1100 W CERMAK RD
Mailing Address - Street 2:SUITE B414
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-4500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 W CERMAK RD
Practice Address - Street 2:SUITE B414
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-4500
Practice Address - Country:US
Practice Address - Phone:312-568-7051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-4241-0007-A261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder