Provider Demographics
NPI:1306066626
Name:LESTER AND ROSALIE ANIXTER CENTER
Entity type:Organization
Organization Name:LESTER AND ROSALIE ANIXTER CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLAIMS ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:OLKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-697-6529
Mailing Address - Street 1:6610 N CLARK ST
Mailing Address - Street 2:FIRST FLOOR OFFICE
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-4062
Mailing Address - Country:US
Mailing Address - Phone:773-761-1501
Mailing Address - Fax:
Practice Address - Street 1:6610 N CLARK ST
Practice Address - Street 2:FIRST FLOOR OFFICE
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-4062
Practice Address - Country:US
Practice Address - Phone:773-761-1501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0405X
ILA-0998-0003-A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========004Medicaid