Nicasa
Clinic/Center, Rehabilitation, Substance Use Disorder in Round Lake, IL. Organization (NPI-2).
NPI number1457573099
StatusActive
Last updated in NPPESApr 6, 2021
Details
- NPI
- 1457573099
- Entity type
- Organization (NPI-2)
- Legal business name
- Nicasa
- Organization subpart
- No
- Enumeration date
- May 3, 2007
- Certification date
- Apr 6, 2021
- Last updated
- Apr 6, 2021
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QR0405X | Clinic/Center, Rehabilitation, Substance Use Disorder | – | – | Yes |
| 251S00000X | Community/Behavioral Health | ca06140005a | IL |
Practice location
31979 N Fish Lkae RdRound Lake, IL 60073
Phone 847-546-6450 · Fax 847-546-6760
Mailing address
31979 N Fish Lkae RdRound Lake, IL 60073
Phone 847-546-6450 · Fax 847-546-6760
Authorized official
Bruce Johnson
Coo
8475466450
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