| Organization Name: | WAY BACK INN |
| NPI Number: | 1730472275 |
| 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: | 05/17/2011 |
| NPI Last Update Date: | 07/02/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 324500000X |
| License Number: | A-0388-0001-A |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Substance Abuse Rehabilitation Facility |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |