South Suburbs Residential – Mental Illness Community Based Residential Treatment Facility, NPI 1790588580

South Suburbs Residential is a healthcare provider. based in Blue island, Illinois. specializing in Mental Illness Community Based Residential Treatment Facility. The NPI Number for South Suburbs Residential is 1790588580

Main info

Organization
Name
South Suburbs Residential
NPI
1790588580
Phone
(773) 572-5500
Address
12145 WESTERN AVE
Authorized Official
MARCELLA KLAUER EXECUTIVE ASSISTANT
Enumeration Date
28 March 2025
Last Update Date
28 March 2025
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience22
Completeness80
Years active:1State licenses:0Digital endpointsUpdated within 12 months

Provider Addresses for South Suburbs Residential

  • 12145 WESTERN AVE

    BLUE ISLAND, IL 604061387

    Phone: (773) 572-5500

    Fax: (773) 572-5240

    Type: Location

  • 4101 N RAVENSWOOD AVE

    CHICAGO, IL 606132193

    Phone: (773) 572-5500

    Fax: (773) 572-5240

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

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Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 60406)

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Reviews

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Frequently asked questions

Can I verify South Suburbs Residential with an NPI only?
You can start verification with NPI 1790588580 for South Suburbs Residential, then check state licensing separately.
Can I rely on South Suburbs Residential being an active provider?
As of the registry snapshot, South Suburbs Residential is marked active.
What is South Suburbs Residential's primary classification?
Mental Illness Community Based Residential Treatment Facility is the headline specialty for South Suburbs Residential here. Clinical services aligned with this taxonomy classification.
What address line appears for South Suburbs Residential?
South Suburbs Residential's geographic hint is Blue Island, Illinois in our summary view.
Is the information about South Suburbs Residential up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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