MEDICARE: NORTH CENTRAL BEHAVIORAL HEALTH SYSTEMS INC.

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1548380975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH CENTRAL BEHAVIORAL HEALTH SYSTEMS INC.

Provider Business Mailing Address
First Line	:	17 NORTHPOINT DR
Second Line	:
City	:	STREATOR
State	:	IL
Zip	:	61364-1159
Country	:	US
Telephone Number	:	815-223-0160
Fax Number	:	815-223-1634

Provider Business Practice Location Address
First Line	:	17 NORTHPOINT DR
Second Line	:
City	:	STREATOR
State	:	IL
Zip	:	61364-1159
Country	:	US
Telephone Number	:	815-223-0160
Fax Number	:	815-223-1634

Authorized Official
Title or Position	:	VP-FINANCE
Name	:	MR. LARRY BLOCK
Credential	:	CPA
Telephone Number	:	815-223-0160

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	08/22/2020

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