Provider Demographics
NPI:1720422959
Name:TRANSITIONAL ALTERNATIVE REENTRY INITIATIVE, INC
Entity Type:Organization
Organization Name:TRANSITIONAL ALTERNATIVE REENTRY INITIATIVE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:KNAZZE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:630-264-0700
Mailing Address - Street 1:PO BOX 673
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60507-0673
Mailing Address - Country:US
Mailing Address - Phone:630-264-0700
Mailing Address - Fax:630-264-0701
Practice Address - Street 1:635 N ELMWOOD DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-2808
Practice Address - Country:US
Practice Address - Phone:630-264-0700
Practice Address - Fax:630-264-0701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA54450002A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health