| Nicasa | |
|
31979 N Fish Lkae Rd Round Lake IL 60073 | |
| (847) 546-6450 | |
| (847) 546-6760 |
| Full Name | Nicasa |
|---|---|
| Speciality | Clinic/center - Rehabilitation, Substance Use Disorder |
| Location | 31979 N Fish Lkae Rd, Round Lake, Illinois |
| Authorized Official Name and Position | Bruce Johnson (COO) |
| Authorized Official Contact | 8475466450 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Nicasa 31979 N Fish Lkae Rd Round Lake IL 60073 Ph: (847) 546-6450 | Nicasa 31979 N Fish Lkae Rd Round Lake IL 60073 Ph: (847) 546-6450 |
| NPI Number | 1457573099 |
|---|---|
| Provider Enumeration Date | 05/03/2007 |
| Last Update Date | 04/06/2021 |
| Certification Date | 04/06/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457573099 | NPI | - | NPPES |
| CA06140002A | Medicaid | IL | |
| CA06140005A | Medicaid | IL | |
| A06140005A | Other | IL | STATE OF ILLINOIS |
| A06140004A | Other | IL | STATE OF ILLINOIS |
| CA06140001A | Medicaid | IL | |
| A06140003A | Other | IL | STATE OF ILLINOIS |
| A06140001A | Other | IL | STATE OF ILLINOIS |
| A06140002A | Other | IL | STATE OF ILLINOIS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | CA06140005A (Illinois) | Secondary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | (* (Not Available)) | Primary |
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