Provider Demographics
NPI:1891045241
Name:ASSOCIATION HOUSE OF CHICAGO
Entity Type:Organization
Organization Name:ASSOCIATION HOUSE OF CHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:HARRIET
Authorized Official - Middle Name:
Authorized Official - Last Name:SADAUSKAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-772-7170
Mailing Address - Street 1:1116 NORTH KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60651
Mailing Address - Country:US
Mailing Address - Phone:773-772-7170
Mailing Address - Fax:
Practice Address - Street 1:1900 NORTH SAWYER AVENUE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651
Practice Address - Country:US
Practice Address - Phone:773-772-7170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-13
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL02805111322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========Medicaid