Provider Demographics
NPI:1992212161
Name:EXOFFENDER TRANSITION CENTER
Entity Type:Organization
Organization Name:EXOFFENDER TRANSITION CENTER
Other - Org Name:REENTRY & REHABILITATION TRANSITION CENTER, NFP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT & CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LANG APPLEWHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MSP, CADC, LCPC
Authorized Official - Phone:312-808-3210
Mailing Address - Street 1:2630 S WABASH AVE REAR
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:312-808-3210
Mailing Address - Fax:312-949-1610
Practice Address - Street 1:2630 S WABASH AVE REAR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2825
Practice Address - Country:US
Practice Address - Phone:312-808-3210
Practice Address - Fax:312-949-1610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1275057705Medicaid
IL14055583Medicaid