14D2086498 CLIA NUMBER - YOUTH OUTREACH SERVICES

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Laboratory Demographics

CLIA Number: 14D2086498

Facility Name: YOUTH OUTREACH SERVICES

Facility Address:
6417 W IRVING PARK RD
CHICAGO, IL
ZIP 60634
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Facility Phone Number: 773 777-7112

Facility Type: Other - OUTPT SUBSTANCE ABUSE TRM

Certificate Type: Waiver

NPI Number: 1568916476

Taxonomy: 251S00000X - Community/Behavioral Health
A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.

CLIA Record

Field Name	Field Value
CLIA Number	14D2086498
LAB Type	Other - OUTPT SUBSTANCE ABUSE TRM
Facility Name	YOUTH OUTREACH SERVICES
Street	6417 W IRVING PARK RD
City	CHICAGO
State	IL
ZIP	60634
Phone	773 777-7112
CertificateType	4
CertificateEffectiveDate	11/5/2022
CertificateExpirationDate	11/4/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024