Provider Demographics
NPI:1811133671
Name:NORTH SHORE ADOLESCENT RECOVERY CENTER
Entity type:Organization
Organization Name:NORTH SHORE ADOLESCENT RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:EDWARDS
Authorized Official - Last Name:EVEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-446-2270
Mailing Address - Street 1:211 WAUKEGAN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-2757
Mailing Address - Country:US
Mailing Address - Phone:847-446-2270
Mailing Address - Fax:847-446-2172
Practice Address - Street 1:211 WAUKEGAN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-2757
Practice Address - Country:US
Practice Address - Phone:847-446-2270
Practice Address - Fax:847-446-2172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-5256-0001-A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health