Provider Demographics
NPI:1356560320
Name:ABACUS PROGRAM
Entity type:Organization
Organization Name:ABACUS PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CADC, LCPC, MISA
Authorized Official - Phone:847-742-0413
Mailing Address - Street 1:555 TOLLGATE RD STE A
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-9314
Mailing Address - Country:US
Mailing Address - Phone:847-742-0413
Mailing Address - Fax:847-742-1393
Practice Address - Street 1:555 TOLLGATE RD STE A
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-9314
Practice Address - Country:US
Practice Address - Phone:847-742-0413
Practice Address - Fax:847-742-1393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA00150001A261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder