Provider Demographics
NPI:1134270036
Name:THERAPEUTIC INTERVENTIONS, INC.
Entity type:Organization
Organization Name:THERAPEUTIC INTERVENTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-991-4800
Mailing Address - Street 1:1645 HICKS RD STE A
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-1222
Mailing Address - Country:US
Mailing Address - Phone:847-991-4800
Mailing Address - Fax:847-991-4866
Practice Address - Street 1:1645 HICKS RD STE A
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-1222
Practice Address - Country:US
Practice Address - Phone:847-991-4800
Practice Address - Fax:847-991-4866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-6192-0001-A261QM2800X
261QR0405X, 261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL50012OtherBC HMO PROVIDER #
IL21622143OtherBC PPO PROVIDER #
IL7511075OtherAETNA PROVIDER #