MEDICARE: ALEXIAN BROTHERS CENTER FOR MENTAL HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1144500109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALEXIAN BROTHERS CENTER FOR MENTAL HEALTH

Provider Business Mailing Address
First Line	:	3350 W SALT CREEK LN
Second Line	:	114
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-5023
Country	:	US
Telephone Number	:	847-952-7460
Fax Number	:	847-222-1754

Provider Business Practice Location Address
First Line	:	1208 E NORTHWEST HWY
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-6793
Country	:	US
Telephone Number	:	847-952-7460
Fax Number	:	847-222-1754

Authorized Official
Title or Position	:	FINANCIAL ANALYST
Name	:	IRENE HAIRGROVE
Credential	:
Telephone Number	:	847-952-7460

Provider Enumeration Date	:	08/23/2011
Last Update Date	:	08/23/2011

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