Nicasa

NPI 1457573099 - Community/Behavioral Health - 251S00000X

NPI Details
NPI 1457573099
Enumeration Date 05/03/2007
Last Updated 05/02/2011
Entity Type Healthcare Provider
Active Over 9 years ago
Authorized Information
Name BRUCE BRUCE
Position COO
Phone (847) 546-6450
Fax (847) 546-6760
Practice Location
31979 N FISH LKAE RD
ROUND LAKE IL, 60073, US
Phone (847) 546-6450
Fax (847) 546-6760
Business Location
31979 N FISH LKAE RD
ROUND LAKE IL, 60073, US
Phone (847) 546-6450
Fax (847) 546-6760
Toxanomy
Taxonomy Code 251S00000X
License State Illinois
License Number CA06140005A
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According to our database, Nicasa NPI is 1457573099, taxonomy code is 251S00000X and license number is CA06140005A, license state is located at Illinois. Nicasa physically located at 31979 N Fish Lkae Rd, Round Lake IL, 60073. NPI Number 1033115704 has the healthcare provider type.

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1457573099 NPI number is provided on an as is basis without warranty of any kind. 1457573099 is maintained by the National Plan & Provider Enumeration System. The contents of Nicasa are for informational purposes only.