Healthcare Provider Details

I. General information

NPI: 1629778550
Provider Name (Legal Business Name): YOUTH CROSSROADS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2023
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 STANLEY AVE
BERWYN IL
60402-3123
US

IV. Provider business mailing address

6501 STANLEY AVE
BERWYN IL
60402-3123
US

V. Phone/Fax

Practice location:
  • Phone: 708-484-7400
  • Fax:
Mailing address:
  • Phone: 708-484-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JOSEPHINE DICESARE
Title or Position: EXECUTIVE DIRECTOR
Credential: MA
Phone: 708-484-7400