Healthcare Provider Details

I. General information

NPI: 1003181678
Provider Name (Legal Business Name): MENTAL HEALTH AND DEAFNESS RESOURCES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2012
Last Update Date: 03/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3024 E OAKLAND AVE
BLOOMINGTON IL
61704-6214
US

IV. Provider business mailing address

614 ANTHONY TRL
NORTHBROOK IL
60062-2540
US

V. Phone/Fax

Practice location:
  • Phone: 309-661-1605
  • Fax:
Mailing address:
  • Phone: 847-509-8260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: GAIL FISHER
Title or Position: ADMINISTRATOR
Credential:
Phone: 847-509-8260