INDEPENDENCE CENTER NPI 1235308057

NPI Information

NPI: 1235308057
Provider Name: INDEPENDENCE CENTER
Classification: Community Based Residential Treatment Facility, Mental Illness - 320800000X
Entity Type: Organization
Address: 817 INDIANA AVE
WAUKEGAN, IL
ZIP 60085
Phone: (847) 360-1020

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NPI Details

INDEPENDENCE CENTER is a community based residential treatment facility mental illness in Waukegan, IL. The provider is a home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. INDEPENDENCE CENTER NPI is 1235308057. The provider is registered as an organization entity type.

The provider's business location address is:

817 INDIANA AVE
WAUKEGAN, IL
ZIP 60085-612
Phone: (847) 360-1020

The provider's authorized official is Michael Pierce .
The authorized official title is Executive Director and has the following contact phone number (847) 244-4442.

The enumeration date for this NPI number is 2/26/2008 and was last updated on 8/3/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Primary
1	251B00000X	Case Management	No
2	251S00000X	Community/Behavioral Health	No
3	320800000X	Community Based Residential Treatment Facility, Mental Illness	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	=========	MEDICAID	ILLINOIS
2	144643	MEDICARE PIN	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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