Provider Demographics
NPI:1992973689
Name:SPECIALIZED ASSISTANCE SERVICES, NFP
Entity type:Organization
Organization Name:SPECIALIZED ASSISTANCE SERVICES, NFP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE & ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-808-3218
Mailing Address - Street 1:2630 S. WABASH
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616
Mailing Address - Country:US
Mailing Address - Phone:312-808-3218
Mailing Address - Fax:312-791-9037
Practice Address - Street 1:2630 S. WABASH
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616
Practice Address - Country:US
Practice Address - Phone:312-808-3218
Practice Address - Fax:312-791-9037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-0584-0001A251S00000X
261QM2800X, 261QR0405X, 276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILA-0584-0002-AMedicaid
ILA-0584-0002-AMedicaid