Provider Demographics
NPI:1720534100
Name:HENRY'S SOBER LIVING HOUSE
Entity Type:Organization
Organization Name:HENRY'S SOBER LIVING HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCGHEE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:773-752-1300
Mailing Address - Street 1:8032 S INGLESIDE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-4223
Mailing Address - Country:US
Mailing Address - Phone:773-752-1300
Mailing Address - Fax:773-752-1302
Practice Address - Street 1:8032 S INGLESIDE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-4223
Practice Address - Country:US
Practice Address - Phone:773-752-1300
Practice Address - Fax:773-752-1302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-26
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder