Provider Demographics
NPI:1285101410
Name:WESTCARE ILLINOIS, INC
Entity type:Organization
Organization Name:WESTCARE ILLINOIS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNROE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-587-0316
Mailing Address - Street 1:1100 W CERMAK RD STE B414
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-4500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 W CERMAK RD STE B414
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-4500
Practice Address - Country:US
Practice Address - Phone:312-568-7051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid