| Organization Name: | WAY BACK INN |
| NPI Number: | 1093060741 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANITA MARIA PINDIUR (INTERIM EXECUTIVE DIRECTOR) |
| Mailing Address: | 1915 W Roosevelt Rd Broadview |
| State: | IL US |
| Postal Code: | 601552925 |
| Phone Number: | 7083443301 |
| Fax Number: | 7083442944 |
| NPI Enumeration Date: | 07/18/2012 |
| NPI Last Update Date: | 07/18/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 180.007316 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |