MC DERMOTT CENTER NPI 1376080572

NPI Information

NPI: 1376080572
Provider Name: MC DERMOTT CENTER
Classification: Community Based Residential Treatment Facility, Mental Illness - 320800000X
Entity Type: Organization
:
CLIA Number: 14D1023353
Address: 108 N SANGAMON ST FL 3
CHICAGO, IL
ZIP 60607
Phone: (312) 226-7984

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NPI Details

MC DERMOTT CENTER is a community based residential treatment facility mental illness in Chicago, IL. The provider is a home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. MC DERMOTT CENTER NPI is 1376080572. The provider is registered as an organization entity type.
The provider .

The provider's business location address is:

108 N SANGAMON ST FL 3
CHICAGO, IL
ZIP 60607-202
Phone: (312) 226-7984
Fax: (312) 226-8048

The provider's authorized official is Dan Lustig .
The authorized official title is President/ceo and has the following contact phone number (312) 226-7984.

The CLIA number assigned to this NPI record is 14D1023353 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/25/2017 and was last updated on 4/2/2025.

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	Taxonomy Specialization	License Number	License State	Primary
1	251B00000X	Case Management				No
2	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)			No
3	320800000X	Community Based Residential Treatment Facility, Mental Illness		17001	ILLINOIS	Yes
4	324500000X	Substance Abuse Rehabilitation Facility				No

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	0349-0056	MEDICAID	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: 11/21/2025

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