Provider Demographics
NPI:1891296802
Name:THE IDS GROUP CHICAGO
Entity Type:Organization
Organization Name:THE IDS GROUP CHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATECHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HESTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CADC
Authorized Official - Phone:312-263-1131
Mailing Address - Street 1:5161 S LAPORTE AVE # 1N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-3060
Mailing Address - Country:US
Mailing Address - Phone:708-935-1821
Mailing Address - Fax:
Practice Address - Street 1:1117 N ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-3986
Practice Address - Country:US
Practice Address - Phone:312-263-1131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-25
Last Update Date:2018-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-2779-0001-A324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility