Provider Demographics
NPI:1700336229
Name:NICASA, NFP
Entity Type:Organization
Organization Name:NICASA, NFP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SNELTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-546-6450
Mailing Address - Street 1:31979 N FISH LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-9517
Mailing Address - Country:US
Mailing Address - Phone:814-546-6450
Mailing Address - Fax:847-546-6760
Practice Address - Street 1:1113 W GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60087-4908
Practice Address - Country:US
Practice Address - Phone:847-244-4434
Practice Address - Fax:847-244-4098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14012261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14012OtherILLINOIS DEPT OF HUMAN SERVICES