NICASA; NPI #1457573099

Contact Information

NICASA

31979 N FISH LKAE RD
ROUND LAKE, IL 60073

Phone: 847-546-6450
Fax: 847-546-6760
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Rehabilitation, Substance Use Disorder	261QR0405X
Community/Behavioral Health	251S00000X

Indicates primary specialty

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NPI Profile & details for NICASA

NPI # 1457573099

LBN Legal business name NICASA

Authorized official BRUCE JOHNSON - (COO)

Entity Organization

Organization subpart ¹ No

Enumeration date 05/03/2007

Last updated 04/06/2021 - About 5 years ago

Identifiers

IL	License #	CA06140005A
IL	Medicaid	CA06140001A
IL	Medicaid	CA06140002A
IL	Medicaid	CA06140005A
IL	Other	A06140001A	STATE OF ILLINOIS
IL	Other	A06140002A	STATE OF ILLINOIS
IL	Other	A06140003A	STATE OF ILLINOIS
IL	Other	A06140004A	STATE OF ILLINOIS
IL	Other	A06140005A	STATE OF ILLINOIS

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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