| Omni Youth Services-ela | |
|
1025 Old Mchenry Rd Lake Zurich IL 60047-8428 | |
| (847) 540-0680 | |
| (847) 540-1427 |
| Full Name | Omni Youth Services-ela |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1025 Old Mchenry Rd, Lake Zurich, Illinois |
| Authorized Official Name and Position | Shanan Egger (CFO) |
| Authorized Official Contact | 8473531762 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Omni Youth Services-ela 1111 W Lake Cook Rd Buffalo Grove IL 60089-1926 Ph: (847) 353-1500 | Omni Youth Services-ela 1025 Old Mchenry Rd Lake Zurich IL 60047-8428 Ph: (847) 540-0680 |
| NPI Number | 1043450562 |
|---|---|
| Provider Enumeration Date | 02/24/2009 |
| Last Update Date | 02/24/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043450562 | NPI | - | NPPES |
| 08005 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 08005 (Illinois) | Primary |
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