Provider Demographics
NPI:1548312788
Name:MEDMARK TREATMENT CENTERS
Entity type:Organization
Organization Name:MEDMARK TREATMENT CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OTP OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:REMY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:REINIER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCPC, CADC
Authorized Official - Phone:708-499-6320
Mailing Address - Street 1:4700 W 95TH ST
Mailing Address - Street 2:SUITE LL5
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2533
Mailing Address - Country:US
Mailing Address - Phone:708-499-6320
Mailing Address - Fax:708-499-6263
Practice Address - Street 1:4700 W 95TH ST
Practice Address - Street 2:SUITE LL5
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2533
Practice Address - Country:US
Practice Address - Phone:708-499-6320
Practice Address - Fax:708-499-6263
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDMARK SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA80120001A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL10154MOtherSAMHSA CERTIFICATION
ILA80120001AOtherSTATE LICENSE
ILRM0334956OtherDEA LICENSE