MEDICARE: GREATER HEIGHTS P MEDICAL SERVICES

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	261QM0850X	Adult Mental Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568099307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER HEIGHTS P MEDICAL SERVICES

Provider Business Mailing Address
First Line	:	1005 S EVERGREEN AVE
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-3144
Country	:	US
Telephone Number	:	847-749-0542
Fax Number	:	630-451-9896

Provider Business Practice Location Address
First Line	:	1005 S EVERGREEN AVE
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-3144
Country	:	US
Telephone Number	:	847-749-0542
Fax Number	:	630-451-9896

Authorized Official
Title or Position	:	MANAGER
Name	:	MARY ODEFADEHAN
Credential	:	APRN
Telephone Number	:	224-659-2484

Provider Enumeration Date	:	03/23/2020
Last Update Date	:	04/07/2020

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